Division of Urology, Department of Surgery and Intensive Care, National Center for Geriatrics and Gerontology, Obu, Japan.Department of Urology, Nagoya University, Graduate School of Medicine, Nagoya, Aichi; Department of Urology, Hokkaido; Urology Memorial Hospital, Sapporo, Hokkaido; Department of Urology, Tohoku Rosai Hospital, Sendai, Miyagi; Department of Urology, Kashiwa City Hospital, Kashiwa, Chiba; Department of Urology, Showa Northern Yokohama Hospital, Yokohama, Kanagawa; Department of Urology, Kainan Municipal Hospital, Kainan, Wakayama; Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
The objective of the present study was to assess the short-term effects of botulinum toxin A (BTX-A) injection for refractory non-neurogenic overactive bladder (OAB) in the setting of a prospective multicenter clinical trial. Refractory OAB was defined as persistent urgency urinary incontinence (UUI) ≥once a week despite taking anticholinergic agents, or the incapability to continue the agents because of the adverse effects. A total of 100 U of BTX-A were reconstituted in 15 mL of normal saline and an aliquot of 0.5 mL was injected at 30 submucosal sites of the bladder wall. Nine men and eight women aged 67 ± 12 years were included. Subjective daytime frequency, urgency and UUI significantly decreased after treatment. On a 3-day frequency-volume chart, the daytime and night-time frequency of UUI significantly decreased from 5.5 and 0.5 pre-injection to 2.0 and 0.3 postinjection, respectively. Daytime urinary incontinence completely disappeared in six subjects. A urodynamic study showed the disappearance of detrusor overactivity in eight patients and a decrease in five patients. Maximum bladder capacity significantly increased from 179.9 to 267.3 mL. Difficulty on micturition or feeling of incomplete emptying was reported by 23.5% and 43.8% of patients at weeks 2 and 4, respectively. Postvoid residual urine increased to >100 mL in seven patients and >200 mL in one patient after injection; however, none of the patients required clean intermittent catheterization. These findings suggest promising efficacy of BTX-A in Japanese OAB patients.
Okamura K, Nojiri Y, Ameda K, Namima T, Suzuki M, Inoue K, Ogawa T, Gotoh M, Homma Y. Are you the author?
Reference: Int J Urol. 2011 Apr 13. Epub ahead of print.