Author/Editor		Leskovar, Jurij; Hajdinjak, Tine
Title		Effect of botulinum toxin type A on idiopathic and neurogenic detrusor overactivity
Translated title		Vpliv toksina botulina na idiopatski in nevrogeni čezmerno aktivni sečni mehur
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 79, št. 6
Publication year		2010
Volume		str. 475-81
Language		eng
Abstract		Objectives: Intra-detrusor botulinum toxin type A injection treatment for detrusor overactivity conditions, where anticholinergic medication fails, has been available as standard treatment in our institution since 2004. Efficacy, indications and pitfalls were assessed, and thoughts on safety and cost-related aspects of this treatment presented. Methods: Retrospective study analyzed eleven consecutive patients (8 with neurogenic detrusor overactivity and 3 with idiopathic detrusor overactivity), treated between 2004 and 2008. All patients were incontinent. Complete urodynamic investigation was performed before and 16 weeks after treatment. Injections of 500U of Dysport in a concentration of 25 U/ml were performed under local anesthesia as an outpatient procedure in most cases. Results: Intra-detrusor botulinum injections alleviated all overactive bladder symptoms and improved urodynamic parameters. In a patient with tetraparesis, autonomic dysreflexia, associated with detrusor overactivity that manifested as hypertensive crisis during voiding, disappeared on the third day of treatment. Complete dryness was achieved in 10/11 patients (91%) while incontinence grade in the remaining patient decreased. One of idiopathic patients who voided spontaneously before treatment had to start self catheterization sixth day after treatment. Satisfaction on a 5 point scale increased from 1,2 before treatment to 3,5 after treatment (p<0,001). 9/11 patients (82%) claimed that they would have treatment again when/if its effect diminished. In our health system, the treatment with Dysport is not more expensive compared to oral anticholinergic medications available. Conclusions: Botulinum is a major treatment option in patient with intractable symptoms of overactive bladder or those unable to tolerate anticholinergic medications.
Summary		Izhodišča: Na našem oddelku kot standardno metodo uporabljamo od leta 2004 inijiciranje toksina botulina tipa A v detruzor pri stanjih s čezmerno aktivnostjo sečnega mehurja, kadar odpove zdravljenje z antiholinergičnimi zdravili. Cilj je bil analizirati indikacije in učinkovitost ter razpravljati o varnosti in stroškovnem vidiku tega zdravljenja. Metode: Retrospektivno smo analizirali 11 zaporednih bolnikov (8 z nevrogenim čezmerno aktivnim sečnim mehurjem in 3 z idiopatskim), zdravljenih med letoma 2004 in 2008. Vsi so bili ob vključitvi inkontinentni. Urodinamska preiskava je bila pri vseh opravljena pred injiciranjem toksina botulina in 16 tednov po njem. Odmerek je znašal 500 enot Dysporta v koncentraciji 25 enot/ml. Poseg je bil v večini primerov opravljen ambulantno v lokalni anesteziji. Rezultati: Injiciranje toksina botulina v detruzor je olajšalo vse simptome čezmerno aktivnega sečnega mehurja in vplivalo na preučevane urodinamske parametre. Pri bolniku s tetraparezo je avtonomna disrefleksija, ki se je kazala kot pogosta hipertenzivna kriza med uriniranjem, izginila tretji dan po zdravljenju. Popolna kontinenca je bila dosežena pri 10/11 bolnikov (91%), pri enem bolniku pa se je znižala stopnja inkontinence. Eden od bolnikov z idiopatskim čezmerno aktivnim sečnim mehurjem, ki je sponatno uriniral pred zdravljenjem, je moral šesti dan po zdravljenju začeti s čisto redno samokateterizacijo. Zadovoljstvo vseh bolnikov, ki smo ga ocenjevali s 5-stopenjsko lestvico, se je povišalo od povprečno 1,2 pred zdravljenjem na povprečno 3,5 po zdravljenju (p<0,001). 9/11 bolnikov (82%) je bilo mnenja, da bi se za zdravljenje ponovno odločili ali bi ga ponovili, če bi ali ko bo učinek popustil. Zdravljenje čezmerno aktivnega sečnega mehurja z zdravilom Dysport v našem zdravstvenem domu ni dražje v primerjavi s peroralnimi antiholinergičnimi zdravili, ki so na razpolago. (Izvleček skrajšan pri 2000 znakih)
Descriptors		BLADDER, NEUROGENIC BOTULINUM TOXIN TYPE A URODYNAMICS TREATMENT OUTCOME