Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity
To investigate the continuous therapeutic effects and urinary incontinence severity after repeated detrusor injections of 200-U of onabotulinumtoxinA (BoNT-A) in chronic spinal cord-injured (SCI) patients. Methods: Between 2006 and 2010, patients with chronic SCI and refractory neurogenic detrusor o...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2015-07-01
|
| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664613003641 |
| _version_ | 1819173887926075392 |
|---|---|
| author | Sheng-Fu Chen Hann-Chorng Kuo |
| author_facet | Sheng-Fu Chen Hann-Chorng Kuo |
| author_sort | Sheng-Fu Chen |
| collection | DOAJ |
| description | To investigate the continuous therapeutic effects and urinary incontinence severity after repeated detrusor injections of 200-U of onabotulinumtoxinA (BoNT-A) in chronic spinal cord-injured (SCI) patients.
Methods: Between 2006 and 2010, patients with chronic SCI and refractory neurogenic detrusor overactivity (DO) were treated with repeated sets of 200-U BoNT-A injected into 20 sites every 6 months. All patients underwent urological examinations and video-urodynamic studies at baseline and after each BoNT-A treatment. The outcomes were measured using Urogenital Distress Inventory 6-item short form (UDI-6) for urinary incontinence. The severity of urinary incontinence and urodynamic parameters were compared after each BoNT-A injection.
Results: A total of 59 SCI patients with a mean age of 42.1 ± 13.1 years were enrolled. The UDI-6 incontinence scores persistently improved for up to three injections. The rate of dryness and mild incontinence reported by patients persistently improved from 25.4% at baseline to 74% at 3 months after the fourth injection, but decreased slightly after the fourth injection. The overall satisfaction rate after single or repeated injections was 59.3% (35 patients), and the failure rate was 33.9% (20 patients), and discontinuation rate owing to adverse events (2 recurrent UTI, 2 autonomic dysreflexia) was 6.8% (4 patients). Among the 20 patients who reported failure to treatment, 10 patients (16.9%) reported no significant improvement after one or repeated injections, eight converted to augmentation enterocystoplasty.
Conclusion: Repeated 200-U BoNT-A injections every 6 months for neurogenic DO in chronic SCI patients provided a satisfactory initial outcome. However, only 20% patients continued the repeated treatment. |
| first_indexed | 2024-12-22T20:30:13Z |
| format | Article |
| id | doaj.art-a02a7c1d5ff24647bdf79892596b2417 |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-22T20:30:13Z |
| publishDate | 2015-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-a02a7c1d5ff24647bdf79892596b24172022-12-21T18:13:37ZengElsevierJournal of the Formosan Medical Association0929-66462015-07-01114758358910.1016/j.jfma.2013.10.009Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivitySheng-Fu ChenHann-Chorng KuoTo investigate the continuous therapeutic effects and urinary incontinence severity after repeated detrusor injections of 200-U of onabotulinumtoxinA (BoNT-A) in chronic spinal cord-injured (SCI) patients. Methods: Between 2006 and 2010, patients with chronic SCI and refractory neurogenic detrusor overactivity (DO) were treated with repeated sets of 200-U BoNT-A injected into 20 sites every 6 months. All patients underwent urological examinations and video-urodynamic studies at baseline and after each BoNT-A treatment. The outcomes were measured using Urogenital Distress Inventory 6-item short form (UDI-6) for urinary incontinence. The severity of urinary incontinence and urodynamic parameters were compared after each BoNT-A injection. Results: A total of 59 SCI patients with a mean age of 42.1 ± 13.1 years were enrolled. The UDI-6 incontinence scores persistently improved for up to three injections. The rate of dryness and mild incontinence reported by patients persistently improved from 25.4% at baseline to 74% at 3 months after the fourth injection, but decreased slightly after the fourth injection. The overall satisfaction rate after single or repeated injections was 59.3% (35 patients), and the failure rate was 33.9% (20 patients), and discontinuation rate owing to adverse events (2 recurrent UTI, 2 autonomic dysreflexia) was 6.8% (4 patients). Among the 20 patients who reported failure to treatment, 10 patients (16.9%) reported no significant improvement after one or repeated injections, eight converted to augmentation enterocystoplasty. Conclusion: Repeated 200-U BoNT-A injections every 6 months for neurogenic DO in chronic SCI patients provided a satisfactory initial outcome. However, only 20% patients continued the repeated treatment.http://www.sciencedirect.com/science/article/pii/S0929664613003641botulinum toxin Aneurogenic detrusoroveractivityincontinencespinal cord injury |
| spellingShingle | Sheng-Fu Chen Hann-Chorng Kuo Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity Journal of the Formosan Medical Association botulinum toxin A neurogenic detrusor overactivity incontinence spinal cord injury |
| title | Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity |
| title_full | Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity |
| title_fullStr | Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity |
| title_full_unstemmed | Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity |
| title_short | Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity |
| title_sort | therapeutic outcome and patient adherence to repeated onabotulinumtoxina detrusor injections in chronic spinal cord injured patients and neurogenic detrusor overactivity |
| topic | botulinum toxin A neurogenic detrusor overactivity incontinence spinal cord injury |
| url | http://www.sciencedirect.com/science/article/pii/S0929664613003641 |
| work_keys_str_mv | AT shengfuchen therapeuticoutcomeandpatientadherencetorepeatedonabotulinumtoxinadetrusorinjectionsinchronicspinalcordinjuredpatientsandneurogenicdetrusoroveractivity AT hannchorngkuo therapeuticoutcomeandpatientadherencetorepeatedonabotulinumtoxinadetrusorinjectionsinchronicspinalcordinjuredpatientsandneurogenicdetrusoroveractivity |