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- W2080492051 abstract "No AccessJournal of UrologyAdult Urology1 Apr 2011Long-Term Effect on Quality of Life of Repeat Detrusor Injections of Botulinum Neurotoxin-A for Detrusor Overactivity in Patients With Multiple Sclerosis Shahid Khan, Xavier Game, Vinay Kalsi, Gwen Gonzales, Jalesh Panicker, Sohier Elneil, Apostolos Apostolidis, Rizwan Hamid, Prokar Dasgupta, Thomas M. Kessler, and Clare J. Fowler Shahid KhanShahid Khan Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author , Xavier GameXavier Game Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Service d'Urologie, Transplantation Rénale et Andrologie, Centre Hospitalier Universitaire Rangueil, Toulouse, France More articles by this author , Vinay KalsiVinay Kalsi Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Financial interest and/or other relationship with Allergan. More articles by this author , Gwen GonzalesGwen Gonzales Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author , Jalesh PanickerJalesh Panicker Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author , Sohier ElneilSohier Elneil Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author , Apostolos ApostolidisApostolos Apostolidis Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Second Department of Urology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece Financial interest and/or other relationship with Allergan, Pfizer and Astellas. More articles by this author , Rizwan HamidRizwan Hamid Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author , Prokar DasguptaProkar Dasgupta Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Department of Urology, Guy's and St. Thomas' Hospitals National Health Service Foundation Trust, London, United Kingdom Financial interest and/or other relationship with Allergan. More articles by this author , Thomas M. KesslerThomas M. Kessler Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Neuro-Urology, University Hospital Balgrist, Spinal Cord Injury Centre, Zürich, Switzerland Financial interest and/or other relationship with Medtonic and Allergan. More articles by this author , and Clare J. FowlerClare J. Fowler Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Financial interest and/or other relationship with Allergan, Astra Tech, Medtronic and Astellas. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.12.002AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We studied the effect of repeat detrusor botulinum neurotoxin type A injections on urinary symptoms, health and quality of life in patients with refractory neurogenic detrusor overactivity secondary to multiple sclerosis. Materials and Methods: This was a prospective, open label, single center study in 137 patients with multiple sclerosis treated with detrusor injections of botulinum neurotoxin type A with observations made from 2002 to 2009. A minimally invasive outpatient technique was used for injection. Patients were asked to contact the department if and when they required repeat treatment. Recurrent detrusor overactivity was then identified on urodynamics. The primary outcomes measured were the change in symptoms and quality of life, as assessed by the Urogenital Distress Inventory, Incontinence Impact Questionnaire and EuroQol-5 Dimensions questionnaires (www.ion.ucl.ac.uk/departments/repair/themes/uroneurology) before and 4 weeks after botulinum treatment. Continence status, the need for clean intermittent self-catheterization before and after injections, and interinjection intervals were also analyzed. Results: Mean Urogenital Distress Inventory and Incontinence Impact Questionnaire 7 scores showed considerable improvement 4 weeks after each treatment even when repeated 6 times. Almost all patients relied on clean intermittent self-catheterization after treatment. Before the first treatment 83% of patients were incontinent but 4 weeks after the first treatment 76% (104 of 137) became completely dry. This efficacy was sustained with repeat injections. The median interval between re-treatments remained constant at 12 to 13 months. Conclusions: Repeated detrusor botulinum neurotoxin type A injections for refractory neurogenic detrusor overactivity in patients with multiple sclerosis have a consistent effect on bladder control, resulting in sustained improvement in quality of life. References 1 : Multiple sclerosis. Lancet2002; 359: 1221. Google Scholar 2 : Course and prognosis of multiple sclerosis assessed by the computerized data processing of 349 patients. Brain1980; 103: 281. Google Scholar 3 : The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Mult Scler2007; 13: 915. Google Scholar 4 : A UK consensus on the management of the bladder in multiple sclerosis. J Neurol Neurosurg Psychiatry2009; 80: 470. Google Scholar 5 : Botulinum injections for the treatment of bladder symptoms of multiple sclerosis. Ann Neurol2007; 62: 452. 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Google Scholar 10 : European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol2004; 45: 510. Google Scholar 11 : Neurogenic detrusor overactivity treated with English botulinum toxin a: 8-year experience of one single centre. Eur Urol2008; 53: 1013. Google Scholar 12 : Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourol Urodyn2006; 25: 110. Google Scholar 13 : Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: clinical and urodynamic results. Eur Urol2009; 55: 705. Google Scholar 14 : Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs?: Preliminary results . J Urol2000; 164: 692. Link, Google Scholar 15 : Clean intermittent self-catheterization after botulinum neurotoxin type A injections: short-term effect on quality of life. Obstet Gynecol2009; 113: 1046. Google Scholar 16 : A comparison of health utility measures for the evaluation of multiple sclerosis treatments. J Neurol Neurosurg Psychiatry2005; 76: 58. Google Scholar 17 : Histologic features in the urinary bladder wall affected from neurogenic overactivity—a comparison of inflammation, oedema and fibrosis with and without injection of botulinum toxin type A. Eur Urol2006; 50: 1058. Google Scholar 18 : Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. Eur Urol2008; 53: 275. Google Scholar 19 : A comparison between the response of patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity to the first intradetrusor injection of botulinum-A toxin. J Urol2005; 174: 984. Link, Google Scholar © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPinto R, Lopes T, Silva J, Silva C, Dinis P and Cruz F (2018) Persistent Therapeutic Effect of Repeated Injections of Onabotulinum Toxin A in Refractory Bladder Pain Syndrome/Interstitial CystitisJournal of Urology, VOL. 189, NO. 2, (548-553), Online publication date: 1-Feb-2013. Volume 185Issue 4April 2011Page: 1344-1349 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsquality of lifebotulinum toxin type Aurinary bladdermultiple sclerosisneurogenicurinary incontinenceAcknowledgmentsReto Kofmehl and Dr. Ulrike Held, Horten Centre for Patient Oriented Research, University of Zurich, Switzerland, assisted with GEEs.MetricsAuthor Information Shahid Khan Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author Xavier Game Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Service d'Urologie, Transplantation Rénale et Andrologie, Centre Hospitalier Universitaire Rangueil, Toulouse, France More articles by this author Vinay Kalsi Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Financial interest and/or other relationship with Allergan. More articles by this author Gwen Gonzales Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author Jalesh Panicker Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author Sohier Elneil Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author Apostolos Apostolidis Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Second Department of Urology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece Financial interest and/or other relationship with Allergan, Pfizer and Astellas. More articles by this author Rizwan Hamid Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom More articles by this author Prokar Dasgupta Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Department of Urology, Guy's and St. Thomas' Hospitals National Health Service Foundation Trust, London, United Kingdom Financial interest and/or other relationship with Allergan. More articles by this author Thomas M. Kessler Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Neuro-Urology, University Hospital Balgrist, Spinal Cord Injury Centre, Zürich, Switzerland Financial interest and/or other relationship with Medtonic and Allergan. More articles by this author Clare J. Fowler Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom Financial interest and/or other relationship with Allergan, Astra Tech, Medtronic and Astellas. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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