Injection of botulinum toxin type a in the bladder detrusor and submucosa in patients with overactive bladder without detrusor overactivity
- Authors: Krivoborodov G.G1, Tur E.I1, Efremov N.S1
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Affiliations:
- RNRMU n. a. N.I. Pirogov
- Issue: No 2 (2015)
- Pages: 31-34
- Section: Articles
- URL: https://journals.eco-vector.com/1728-2985/article/view/280569
- ID: 280569
Cite item
Abstract
The objective of the study was to compare the efficacy and safety of injections of botulinum toxin type A in the submucosal layer of the bladder and in detrusor in patients who were refractory to anticholinergic therapy of overactive bladder without detrusor overactivity. 100 U botulinum toxin type A was diluted in 10 ml of 0.9% saline and injected with 0.5 ml (5 units) of this solution in 20 points of the bladder (the back and side walls except Letto triangle). In twenty-two patients (the first group) botulinum toxin was injected into the submucosal layer of the bladder, while in 34 patients (second group) - into the detrusor. In the first group after 1 and 3 months 3 (14%) patients and after 6 months 2 (9%) patients had positive treatment outcomes (improvement of symptoms in more than 50%). In 22 (65%) of the 34 patients of the second group positive results were observed at 1 and 3 months and in 17 (50%) - at 6 months. After 9 months, all patients had a relapse of urgent and frequent urination. Difficulties in emptying the bladder were observed in three (9%) of the second group patients who had to resort to periodic self-catheterization for 2-20 weeks. The obtained results allow us to state that the injections of 100 U of botulinum toxin type A in the submucosal layer of the bladder are ineffective in patients with overactive bladder without detrusor overactivity, whereas injections in the detrusor lead to a statistically significant improvement in symptoms of urgent and frequent urination for 6 months.
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About the authors
G. G Krivoborodov
RNRMU n. a. N.I. Pirogov
Email: dr.krivoborodov@hotbox.ru
Department of Urology (Acting Head of Department
E. I Tur
RNRMU n. a. N.I. PirogovDepartment of Urology (Acting Head of Department
N. S Efremov
RNRMU n. a. N.I. PirogovDepartment of Urology (Acting Head of Department
References
- American Association of Urology. Diagnosis and Treatment Algorithm: AUA/SUFU Guideline on Neurogenic Overactive Bladder in Adults. Guidelines, 2014.
- European Association of Urology. Guidelines on Urinary Incontinence. 2014. P. 102-103.
- Ginsberg D., Gousse A., Keppenne V., Sievert K.D., Thompson C., Lam W., Brin M.F., Jenkins B, Haag-Molkenteller C. Phase 3 efficacy and tolerability study of onabotulinumtoxin A for urinary incontinence from neurogenic detrusor overactivity. J. Urol. 2012;187(6):2131-2139.
- Nitti V.W., Dmochowski R., Herschorn S., Sand P., Thompson C., Nardo C., Yan X., Haag-Molkenteller C.; EMBARK Study Group. Onabotulinumtoxin A for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J. Urol. 2013;189(6):2186-2193.
- Sahai A., Dasgupta P., Khan M.S. Is botulinum A toxin an effective treatment for idiopathic detrusor overactivity and sensory urgency? Nat. Clin. Pract. Urol. 2007;4(3):136-137.
- Кривобородов Г.Г., Васильев А.В., Шумило Д.В., Иванов А.В., Тур Е.И. Внутридетрузорные инъекции ботулинического токсина типа А у больных с гиперактивным мочевым пузырем. Урология. 2010;3:36-40.
- Roosen A., Datta S.N., Chowdhury R.A., Patel P.M., Kalsi V., Elneil S., Dasgupta P., Kessler T.M., Khan S., Panicker J., Fry C.H., Brandner S., Fowler C.J., Apostolidis A. Suburothelial myofibroblasts in the human overactive bladder and the effect of botulinum neurotoxin type A treatment. Eur. Urol. 2009;55(6):1440-1448.
- Datta S.N., Roosen A., Pullen A., Popat R., Rosenbaum T.P., Elneil S., Dasgupta P., Fowler C.J., Apostolidis A. Immunohistochemical expression of muscarinic receptors in the urothelium and suburothelium of neurogenic and idiopathic overactive human bladders, and changes with botulinum neurotoxin administration. J. Urol. 2010;184(6):2578-2585.
- Abrams P., Cardozo L., Fall M., Griffiths D., Rosier P., Ulmsten U., van Kerrebroeck P., Victor A., Wein A. Standardisation Sub-committee of the International Continence Society. The Standardization of terminology of lower urinary tract function: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol. Urodyn. 2002;21:167-178.
- Guralnick M.L., Grimsby G., Liss M., Szabo A., O’Connor R.C. Objective differences between overactive bladder patients with and without urodynamically proven detrusor overactivity. Int. Urogynecol. J. 2010;21:325-329.
- Haylen B.T., Chetty N., Logan V., Schulz S., Verity L., Law M., Zhou J. Is sensory urgency part of the same spectrum of bladder dysfunction as detrusor overactivity? Int. Urogynecol. J. 2007;18:123-128.
- Michel M.C., Chapple C.R. Basic mechanisms ofurgency: preclinical and clinical evidence. Eur. Urol. 2009;56(2): 298-307.
- De Groat W.C. The urothelium in overactive bladder: Passive bystander or active participant? Urology. 2004;64:7-11.
- Орлова О.Р., Яхно Н.Н. Применение ботокса (токсина ботулизма типа А) в клинической практике. Руководство для врачей. М., 2001.
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