[Long-term outcomes of intradetrusor botulinum toxin A in multiple sclerosis patients]

Prog Urol. 2019 Mar;29(3):156-165. doi: 10.1016/j.purol.2019.02.003. Epub 2019 Mar 14.
[Article in French]

Abstract

Introduction: The objective of this study was to analyze the long-term efficiency and tolerance of TB in the management of anticholinergic refractory hyperactive bladder in patients with MS.

Material and method: Retrospective mono-centric cohort study of all patients with MS who had a TB injection for anticholinergic refractory hyperactivity from 2005 to 2015. The primary endpoint was clinical efficiency based on the frequency of urinary leakage and symptomatic urinary tract infections.

Results: One hundred and nineteen patients received the first injection. Median follow-up was 26.5 months. After an injection, there was a significant decrease in the number of leaks, with 69.7% of patients without leaks and 93.3% of patients without urinary tract infections. After 7 injections 44% of the patients were still dry and 62.07% had no symptomatic urinary tract infections. The failure rate was 24.37%, the average duration before discharge was 34.7 months. 19 (66%) patients stop treatment for loss of efficacy, 9 (31%) for disease progression and 1 (3%) for cessation of treatment without cause. Of the 774 injections performed, there were complications for 26 of them (3.35%).

Conclusion: Botulinum toxin remains the second-line reference treatment for detrusor overactivity of neurological origin. There is, at least in the short term, a good answer in a large number of cases. This response can be maintained for many years, especially if patients use intermittent catheterization, with excellent tolerance.

Level of evidence: 4.

Keywords: Botulinium toxin A; Hyperactivité vésicale réfractaire aux anticholinergiques; Incontinence urinaire; Multiples sclerosis; Neurogenic bladder; Refractory neurogenic detrusor overactivity; Sclérose en plaque; Toxine botulique; Urinary incontinence; Urinary infection; Vessie neurologie.

MeSH terms

  • Adult
  • Aged
  • Botulinum Toxins, Type A / administration & dosage*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Injections
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Neuromuscular Agents / administration & dosage*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Urinary Bladder, Overactive / drug therapy*
  • Urinary Bladder, Overactive / etiology
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / prevention & control

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A