Tuesday, 11 December 2012

Research: bladder botox 5-year follow-up

#MSBlog: Bladder botox continues to work in over 50% of treated MSers. 

Gaillet et al. Five years follow-up study and failures analysis of Botulinum toxin repeated injections to treat neurogenic detrusor overactivity. Prog Urol. 2012;22:1064-70. doi: 10.1016/j.purol.2012.10.006.

INTRODUCTION: The aim of this work was to follow prospectively a cohort of MSers suffering from neurogenic overactive bladder, treated by botulinum toxin A, study the efficiency of this treatment, analyse the primary failures, secondary and surrender.

PATIENTS AND METHODS: Thirty-one MSers suffering from neurogenic OAB received a detrusor injection of 300 units of Botox™ and were followed prospectively (median 5 years). They were evaluated by voiding diary, Qualiveen™ questionnary and urodynamics before treatment, 2 months after the first injection and the last re-injection.

RESULTS: Five years after the beginning of the treatment, 17 MSers of 31 (54.8%) were still injected, it means 60.7% of the primary responders. Eleven MSers had left the treatment, after at least one effective injection. They identified three reasons of surrender: echapment* of treatment for two MSers of 11 (7.1%); cessation of self catheterize for six MSers of 11 (54.6%) and the surrender of the treatment without clinical or urodynamical failure, for three MSers of 11 (27.3%). Although the cessation of self catheterize was more frequent for MSers suffering from MS, no predictive factor of surrender was statically significant.

"Not sure what echapment means; I assume it is the french term echappement, which means exhaust."

CONCLUSION: In this series, bladder BTA injections was efficient at middle term to treat neurogenic OAB. The echapment was a rare event (7%). The major cause of surrender was the increase difficulty to self catheterize, due to progression of disability, more frequent for patients suffering of multiple sclerosis.



"Botox paralyses the bladder, i.e. makes the muscle go flabby. This increases the volume of the bladder and prevents contractions of the bladder that result in the urge to pass urine frequently. Once the bladder is paralysed you need to use intermittent self-catheterisation to empty the bladder. The usual cause of the latter to fail is arm tremor or severe adductor spasms that prevent easy access to urethra to allow self-catheterisation. If this occurs most MSers then need to have a permanent suprapubic catheter inserted. It is reassuring to note from this study that at 5 years over 50% of MSers receiving botox for bladder dysfunction will sill using it. This mirrors my personal experience with botox that MSers find it very useful."

2 comments:

  1. It seems to me, accessing these treatments is the hardest piece of the jigsaw, suggestions on how to to do it would be appreciated.

    Regards as always.

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  2. Joan Price said
    My aunt has a neurogenic bladder and has to rely on self catheterization. It is trying for her, and the doctor suggested Botox treatments, and I've been doing research to find out more about it. I appreciate you sharing this information, and I'm glad to read it has promising results.

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