Assessing Effectiveness of ‘Onabotulinumtoxin A’ (Botox®) Intradetrusor Injection for Overactive Bladder Patients after Endoscopic Interventions for Benign Prostatic Hyperplasia

Urge urinary incontinence (UUI) is a chronic debilitant condition that characterize some overactive bladder (OAB) patients in absence of any urinary tract infection (UTI). In our center we use intradetrusor injection of ‘Onabotulinum toxin A’ as second step after medical therapy failure in men who have underwent also to endoscopic surgery for BPH. The objective of this study is to verify the improvement in the patients' quality of life (QoL) and also to evaluate the effective dose over time. We observed 40 male patients between January 2019 and January 2021, previously treated with oral drugs (anti-muscarinic and/or beta-3 adrenergic) and with surgical endoscopic approach (TURP, HoLEP, ThuLEP), 10 of these had pathologies - 4 of them neurological. These last patients were injected by 200U, all the others (36) by 100U - Botox®; Allergan, Irvine, CA, USA. Follow-up included monitoring of the following parameters at 3,6,12,24 months: urinary leaks (PAD test), Clean Intermittent Catheterization (CIC), OAB questionnaires, side effects. All patients underwent urodynamic examination before and 6 months after injection. The mean age was 60 years. 2 patients (5%) had early adverse effects after injection (1 vomiting, 1 pelvic pain), 4 (10%) needed CIC at 3 months, 1 of them also at 6 months (he was among the 4 neurological patients who underwent 200U dose). 38 (95%) answered positively to the questionnaire. Botox® treatment showed a reduction in urinary leakage at 3 and 6 months compared to medical therapy and a significant lowering of Pdet at 6 months (p<0.05). Both 100U and 200U doses proved to be effective up to one year after endoscopic treatment (p<0.05). The side effects at 3 months were 1 haematuria and 3UTI - 1 also recurred at 6 and 12 months. Botox® is a valid therapeutic option for OAB patients. 100U appears as an effective dose, however after 12 months it seems to lose its effect. There were no clinical relevant differences between 100 and 200U doses. Intradetrusor injection of ‘onabotulinum toxin A’ can be applied also in men affected by BPH who have previously undergone endoscopic prostatic surgery.

https://www.stephypublishers.com/tunr/pdf/TUNR.MS.ID.000508.pdf


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