Article of the Week: The botulinum toxin benefit for overactive bladder
Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post.
In addition to the article itself, there is an accompanying blog written by a prominent member of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.
If you only have time to read one article this week, it should be this one.
Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB)
Amar Mohee, Ayisha Khan, Neil Harris, Ian Eardley
OBJECTIVES
• To assess the long-term compliance with repeated injections of intravesical botulinum toxin (BT) in a ‘real-life’ mixed population of patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity.
• To identify the reasons why patients discontinued BT therapy and to explore the outcomes of those patients who did discontinue treatment.
PATIENTS AND METHODS
• Retrospective evaluation of the case notes of a series of patients who had received intravesical BT treatment at a large UK teaching hospital.
• No antibiotic prophylaxis was given for the procedure.
RESULTS
•Over a period of 7 years, 268 patients were initiated on intravesical BT treatment for overactive bladder (OAB) at our institution, with 137 followed up for ≥36 months, with 80 patients having ≥60 months follow-up after their first injection.
• Almost two-thirds of patients (61.3%) had discontinued intravesical BT therapy at 36 months, with a 63.8% discontinuation rate at 60 months.
• The main reasons for discontinuation were tolerability issues, mainly urinary tract infections and the need for clean intermittent self-catheterisation. Primary and secondary losses of efficacy were of secondary importance.
• Most of the patients that discontinued have remained under urology care and now receive alternative methods of treatment.
CONCLUSIONS
• Intravesical BT therapy is an effective short-term treatment for OAB.
• With time, two-thirds of patients discontinued treatment usually because of the tolerability issues associated with treatment.
Congratulations on an excellent article of the week from Leeds. This was keenly discussed at the BAUS/SARS annual academic section meeting in London yesterday.
We have maintained prospective databases of our patients treated with Onabotulinumtoxin A at Queen Square and Guy’s for 10 years. Our long term experience with repeat injections is rather different with much lower drop out rates and excellent patient satisfaction. We have had to perform ileocystoplasty on only a couple of patients in this time period.
The main difference may be that the current study is retrospective. Case note reviews are perhaps not the ideal way to ascertain long term results.
That being said, the hunt for the ideal treatment for OAB continues and this timely article is a reminder of the need to engage in fundamental research to understand the pathophysiology of this condition which is more common than most cancers that urologists manage.
Prokar Dasgupta and Arun Sahai
King’s Health Partners