Efficacy and safety of botulinum toxin non-neurogenic administration, a single center, single surgeon 7 years experience
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Piotr Dzigowski, Piotr Radziszewski, Andrzej Borkowski

Katedra i Klinika Urologii Ogólnej, Onkologicznej i Czynnościowej Uniwersytetu Medycznego w Warszawie

summary

Introduction.

Botulinum toxin type A(BoNT-A) is currently used to treat various functional disorders of micturition. It is considered a second-line treatment of choice for neurogenic bladder, however it’s use for non-neurogenic voiding dysfunctions is still limited. Some urologists are still afraid of treatment complications such as paralysed bladder and paralysed sphincter.

Objectives.

We present our 7 years experience of BoNT-A use in non-neurogenic urological conditions.

Materials and methods.

Between 2000 and 2007, 145 patients in an age from 8 to 84 years (mean 48.6) were treated in our Department. 110 of them were females and 35 males. Both preparations of BoNT-A were used (Botox and Dysport). BoNT-A was administered either under short intravenous or under spinal anaesthesia into the detrusor, into the bladder neck and into the external urethral sphincter. Patients were followed-up after injection for 6 months up to 5 years.

Results.

The indications for BoNT-A treatment were: painful bladder (85 patients); bladder overactivity resistant to anticholinergic therapy (60 patients). The following protocols were used: trigonal and posterior bladder wall injections (81 patients); doses: 50-100u Botox, 200-500u Dysport; trigonal and bladder neck injections (14 patients), doses: trigone 50-100 u, bladder neck 50u; trigonal and sphincter injections (20 patients), doses: trigone 50-100u , sphincter 50-100u; sphincter injections (30 patients), doses: 30-100u. The choice of protocol depended on the results of urodynamic studies (inculding urethral profilometry). Generally, sphincteric injections were used if detrussor/sphincter dyscoordination and elevated maximum urethral closing pressure were diagnosed, bladder neck injections were applied in case of outflow obstruction

without sphincteric dyscoordination and detrusor injections alone were used if no other than detrusor abnormalities were found. Dysport was initially used for bladder injections in 15 patients, but was abandoned due to 5 cases of general reactions (high fever, weakness) which occurred during the first 24 hours after the injection. These side effects were however mild and transient. No such reactions were observed for Botox. As for the other complications, we did not observe any serious side effects of BoNT-A administration. In 3 patients with painful bladder a prolonged bleeding (up to48 hours) from the injection sites was observed, but resolved spontaneously. No cases of detrussor acontractility and stress incontinence due to sphincteric paralysis were observed. The overall efficacy of the treatment was 60% for the painfull bladder (mean duration 5.5months) and 75% for the bladder overactivity (mean duration 8.5 months).

Conclusions.

Botulinum toxin is safe and effective treatment of various functional disorders of micturition. Functional studies of the lower urinary tract are essential for the treatment planning.