OnabotulinumtoxinA injections in men with refractory idiopathic detrusor overactivity

To establish the effectiveness and safety profile of BTX-A in men with idiopathic detrusor overactivity (IDO) and compare with the outcomes observed in women. Several randomized trials have demonstrated the effectiveness of intradetrusor Onaboulinum Toxin A (BTX-A) injections in improving symptoms and quality of life (QoL) in patients with overactive bladder (OAB) symptoms. Most trials however contained relatively few men or excluded men altogether.

Data patient undergoing BTX-A for refractory OAB with IDO on urodynamics were extracted from our centre's prospectively maintained database. IIQ-7 and UDI-6 scores were collected at baseline and four to 12 weeks together with data regarding urinary retention requiring clean intermittent self-catheterization (CISC) and urinary tract infection (UTI). Urodynamic studies were assessed where available to see if voiding dysfunction and CISC were predictable.

65 Men received 133 BoNT-A treatments in the 15 year period representing 27.8% of those with refractory OAB. Baseline UDI-6 and IIQ-7 fell by 4.2 (p=0.00) and 6.0 (p=0.00) points for men and by 6.0 (p=0.00) and 11.1 (p=0.00) for women, respectively. De novo CISC was required in 46 (42.6%) men and 107 (35.3%) women (p=0.10). UTI was reported in 36 (29.0%) men and 86 (27.0%) women (p=0.73). The bladder outflow obstruction index and the bladder contractility index did not reliably predict CISC requirement.

Men with refractory OAB experience significant improvement in QoL scores following BTX-A, though the benefit appears greater in women. The requirements for CISC and UTI rates were similar between sexes.

Urology. 2018 Sep 25 [Epub ahead of print]

N Faure Walker, O Syed, S Malde, C Taylor, A Sahai

Department of Urology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK. Electronic address: ., Department of Urology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK., Department of Urology, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK. Electronic address: .