Botulinum toxin type A injection after failure of augmentation enterocystoplasty performed for neurogenic detrusor overactivity: preliminary results of a salvage strategy. The ENTEROTOX study.

To evaluate the clinical efficacy, urodynamic effect and safety of Botulinum Toxin A (BTXA) injections after failure of augmentation enterocystoplasty (AE) performed for NDO.

We performed a multicenter retrospective study that included patients who had AE and at least one injection of BTXA after AE in 15 GENULF (French Speaking Neuro-Urology Study Group) centers. Clinical and urodynamic data were collected from medical files according to a standardized questionnaire and colligated in an anonymous database.

Thirty-three patients with an injection of BTXA after AC in 9 out of 15 centers were included. Mean age at the time of AE was 24 ± 15 years. Overall efficacy (defined by clinical efficacy associated with a request by the patient for reinjection) was observed in 58% of the patients. Mean maximum cystomanometric capacity (MCC) increased by 28% (333 ± 145 vs. 426 ± 131 ml; P = 0.007) and maximum detrusor pressure (PDet max) decreased by 43% (44 ± 37 vs. 25 ± 18 cmH2O; P = 0.02) after BTXA. Only one side effect was recorded out of the 152 procedures (transient generalized muscle weakness without respiratory distress).

In patients with failure after AE performed for NDO, injection of BTXA in the enlarged bladder was effective in over half of the cases with low morbidity. If this therapeutic approach were confirmed, it could be proposed as an alternative to AE surgical revision.

Urology. 2019 Mar 26 [Epub ahead of print]

Floriane Michel, Carine Ciceron, Benjamin Bernuz, Romain Boissier, Sarah Gaillet, Alexia Even, Emmanuel Chartier-Kastler, Pierre Denys, Xavier Gamé, Alain Ruffion, Loïc Le Normand, Brigitte Perrouin-Verbe, Christian Saussine, Andrea Manunta, Véronique Forin, Marianne De Seze, Philippe Grise, Hubert Tournebise, Brigitte Schurch, Gilles Karsenty

Department of Urology, University Hospital of Marseille, Marseille, France., Department of Physical Medicine and Rehabilitation, Renée-Sabran Hospital, University Hospital of Lyon, Lyon, France., Department of Physical Medicine and Rehabilitation, Leon Berard Hospital, Hyères, France., Department of Urology, Aix Marseille University, Marseille, France., Department of Physical Medicine and Rehabilitation, Raymond-Poincaré Hospital, Garches, France., Department of Urology, Pitié-Salpétrière Academic Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France., Department of Urology, University Hospital of Toulouse, Toulouse, France., Department of Urology, University Hospital of Lyon, Lyon, France., Department of Urology, University Hospital of Nantes, Nantes, France., Physical Medicine and Rehabilitation Department, Nantes University Hospital, Saint-Jacques Hospital, Nantes, France., Department of Urology, Strasbourg University Hospital, Strasbourg University, Strasbourg, France., Department of Urology, University of Rennes, Rennes, France., Department of Pediatric Physical Therapy and Rehabilitation, Trousseau Hospital, Paris, France., Department of Neurourology, Clinique Saint-Augustin, Bordeaux, France., Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France., Department of Clinical Neurosciences, Neuropsychology and Neurorehabilitation Service Vaudois University Hospital of Lausanne, Switzerland., Department of Urology, Aix Marseille University, Marseille, France. Electronic address: .