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657 More than 15 years experience with intradetrusor onabotulinumtoxinA injections for treating refractory neurogenic detrusor overactivity: Lessons to be learned
657
More than 15 years experience with intradetrusor onabotulinumtoxinA injections for treating refractory neurogenic detrusor overactivity: Lessons to be learned Eur Urol Suppl 2016;15(3);e657
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Tornic J. 1 , Leitner L. 2 , Guggenbühl S. 1 , Walter M. 1 , Knüpfer S. 1 , Schneider M.P.3 , Mehnert U.1 , Kessler T.M.1 1 Balgrist
University Hospital, Dept. of Neuro-Urology, Zürich, Switzerland, 2 Balgrist University Hospital and University Hospital of Basel,
Dept. of Neuro-Urology/Urology, Zürich and Basel, Switzerland, 3 ETH Zürich, Brain Research Institute, Zürich, Switzerland INTRODUCTION & OBJECTIVES: Intradetrusor onabotulinumtoxinA injections have become a well-established and widely accepted therapy for refractory neurogenic detrusor overactivity (NDO). However, little is known about long-term outcomes. The aim of this study was to assess long-term outcomes of onabotulinumtoxinA injections and patients’ adherence to treatment. MATERIAL & METHODS: A consecutive series of 52 patients who underwent first intradetrusor onabotulinumtoxinA injections for refractory NDO ≥ 9 years ago were prospectively evaluated at a single university spinal cord injury (SCI) centre. RESULTS: Mean duration since the first intradetrusor onbotulinumtoxinA injections was 11±2 years. Most patients (32/52, 61%) suffered from SCI, 15% (8/52) from spina bifida, 14% (7/52) from multiple sclerosis (MS), and the remaining from other neurological disorders. Almost 60% (30/52) of all patients are continuing with intradetrusor onabotulinumtoxinA injections, but only 14% (1/7) of the patients with MS. Lack of clinical and urodynamic response (12/52, 23%) and switching to another treatment (neuromodulation and antimuscarinics) despite appropriate onabotulinumtoxinA efficacy (10/52, 19%) were the reasons for discontinuation. In patients continuing intradetrusor onabotulinumtoxinA treatment, the effect was sustained after repeat injections. CONCLUSIONS: Although intradetrusor onabotulinumtoxinA injections is a highly effective therapy for refractory NDO, about 40% of the patients will discontinue treatment over time. All prospective neurological patients should be informed about this and it needs to be considered in the treatment decision-making process.
More than 15 years experience with intradetrusor onabotulinumtoxinA injections for treating refractory neurogenic detrusor overactivity: Lessons to be learned Eur Urol Suppl 2016;15(3);e657
Print! Print!
Tornic J. 1 , Leitner L. 2 , Guggenbühl S. 1 , Walter M. 1 , Knüpfer S. 1 , Schneider M.P.3 , Mehnert U.1 , Kessler T.M.1 1 Balgrist
University Hospital, Dept. of Neuro-Urology, Zürich, Switzerland, 2 Balgrist University Hospital and University Hospital of Basel,
Dept. of Neuro-Urology/Urology, Zürich and Basel, Switzerland, 3 ETH Zürich, Brain Research Institute, Zürich, Switzerland INTRODUCTION & OBJECTIVES: Intradetrusor onabotulinumtoxinA injections have become a well-established and widely accepted therapy for refractory neurogenic detrusor overactivity (NDO). However, little is known about long-term outcomes. The aim of this study was to assess long-term outcomes of onabotulinumtoxinA injections and patients’ adherence to treatment. MATERIAL & METHODS: A consecutive series of 52 patients who underwent first intradetrusor onabotulinumtoxinA injections for refractory NDO ≥ 9 years ago were prospectively evaluated at a single university spinal cord injury (SCI) centre. RESULTS: Mean duration since the first intradetrusor onbotulinumtoxinA injections was 11±2 years. Most patients (32/52, 61%) suffered from SCI, 15% (8/52) from spina bifida, 14% (7/52) from multiple sclerosis (MS), and the remaining from other neurological disorders. Almost 60% (30/52) of all patients are continuing with intradetrusor onabotulinumtoxinA injections, but only 14% (1/7) of the patients with MS. Lack of clinical and urodynamic response (12/52, 23%) and switching to another treatment (neuromodulation and antimuscarinics) despite appropriate onabotulinumtoxinA efficacy (10/52, 19%) were the reasons for discontinuation. In patients continuing intradetrusor onabotulinumtoxinA treatment, the effect was sustained after repeat injections. CONCLUSIONS: Although intradetrusor onabotulinumtoxinA injections is a highly effective therapy for refractory NDO, about 40% of the patients will discontinue treatment over time. All prospective neurological patients should be informed about this and it needs to be considered in the treatment decision-making process.