Trigonal-sparing versus trigonal-involved Botox injection for treatment of idiopathic overactive bladder: A randomized clinical trial.

To evaluate safety and efficacy of trigone-involved Botox injections in comparison with trigone-sparing injections in refractory idiopathic overactive bladder (OAB).

One hundred and three patients randomly received a 100-IU intradetrusal injection of Botox either sparing the trigone (52 patients) or involving the trigone (51 patients). Patients were prospectively evaluated at 1, 3, and 6 months. Efficacy was evaluated by 3-day voiding diaries, OAB symptom score (OABSS), and pressure flow study. Any complications were recorded. An ascending cystogram was done at 3 months for detection of vesicoureteral reflux. Urinary tract infection (UTI) was estimated on urine culture basis. Primary outcome was the difference of total OABSS at 3 months.

The mean age ± SD was 34.3 ± 10 years (range 18-59 years). There was a reduction of episodes of all components of OAB in both groups in comparison with baseline by the end of the study but without significant difference between both groups. The trigonal-sparing group had less score of frequency compared with the trigonal-involved group throughout the study period (P < .05). There was no difference in OABSS at 3 months (1.5 ± 0.4 vs 1.6 ± 0.3, P .875). Two patients in the trigonal-involved group out of 51 (3.9%) were in need of clean intermittent catheterization because of voiding difficulty and a postvoid residual > 200 mL. There was a higher rate of UTI in the trigonal-involved group ranging from 5.6% up to 11.7% at each follow-up visit. No patient had reflux.

Trigone injections are not superior to trigone-sparing injections. On the contrary, the incidence of UTI and voiding difficulty were higher. The concept of reflux induced by trigonal injection has not been proven.

Lower urinary tract symptoms. 2020 Jun 16 [Epub ahead of print]

Ahmed S El-Hefnawy, Mohamed A Elbaset, Diaa-Eldin Taha, Bassem S Wadie, Mahmoud Kenawy, Ahmed A Shokeir, Mohamed E Badry

Urology Department, Mansoura Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt., Urology Department, Kafr El Sheikh University, Kafr El Sheikh, Egypt., Urology Department, El Menia University, El Menia, Egypt.

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