Intradetrusor injections of botulinum toxin A in adult patients with spinal dysraphism

The aim of the present study was to report the outcomes of botulinum toxin A (BTX-A) intradetrusor injections in adult patients with spina bifida.

All patients with spinal dysraphism who had undergone intradetrusor injections of BTX-A from 2002 to 2016 in 14 centers were included retrospectively. The primary endpoint was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis were performed to seek for predictors of global success.

125 patients were included with a global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters improved significantly at 6-8 weeks compared to baseline including maximum detrusor pressure (-12 cmH2O; p<0.001), maximum cystometric capacity (+86.6 ml ; p<0.001) and compliance (+8.9 ml/cmH2O ; p=0.002). Out of 561 intradetrusor BTX-A injections, 20 complications were recorded (3.6%) with three muscular weaknesses. Global success rate of the first injection was significantly lower in case of poor compliance (34.4% vs. 86.9%; OR=0.08; p<0.001). In multivariate analysis, poor compliance was associated with lower global success rate (OR=0.13; p<0.001) and female gender (OR=3.53; p=0.01) and age (OR=39.9; p<0.001) were predictors of global success.

Intradetrusor BTX-A injections were effective in adult spina bifida patients exhibiting detrusor overactivity. In contrast, the effectiveness was much lower in adult spina bifida patients with poor bladder compliance. The other predictors of global success were female gender and older age.

The Journal of urology. 2018 May 07 [Epub ahead of print]

Benoit Peyronnet, Alexia Even, Grégoire Capon, Marianne de Seze, Juliette Hascoet, Xavier Biardeau, Maximilien Baron, Marie-Aimée Perrouin-Verbe, Jean-Michel Boutin, Christian Saussine, Véronique Phé, Loic Lenormand, Emmanuel Chartier-Kastler, Jean-Nicolas Cornu, Gilles Karsenty, Andrea Manunta, Brigitte Schurch, Pierre Denys, Gérard Amarenco, Xavier Game, Groupe d’Etude de Neuro-Urologie de Langue Française (GENULF) and the committee of NeuroUrology of the French Association of Urology (AFU)

Department of Urology, University of Rennes, Rennes, France; French referral network of Spina Bifida, Rennes University Hospital, Rennes, France. Electronic address: ., Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France., Department of Urology, University of Bordeaux, Bordeaux, France., Department of NeuroUrology, clinique Saint-Augustin, Bordeaux, France., Department of Urology, University of Rennes, Rennes, France; French referral network of Spina Bifida, Rennes University Hospital, Rennes, France., Department of Urology, University of Lille, Lille, France., Department of Urology, University of Rouen, Rouen, France., Department of Urology, University of Nantes, Nantes, France., Department of Urology, University of Tours, Tours, France., Department of Urology, University of Strasbourg, Strasbourg, France., Department of Urology, Medecine Sorbonne Universite, Paris, France., Department of Urology, University of Marseille, Marseille, France., Department of NeuroUrology, University of Lausanne, Lausanne, Switzerland., Sorbonne Université, GRC 01 GREEN, APHP, Hôpital Tenon, Paris, France., Department of Urology, University of Toulouse, 31000 Toulouse, France.

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