Botulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in Patients with Multiple Sclerosis

Abstract

Introduction
Lower Urinary tract symptoms are common in patients with multiple sclerosis (MS) and have a negative influence on the quality
of life (QoL). Detrusor overactivity is the most frequent symptom. Lifestyle modifications are the first therapeutic line followed
by oral medication in patients with storage dysfunction. When these drugs are ineffective or intolerable, botulinum toxin bladder
injection is an alternative treatment. The aim of this work is to evaluate the effectiveness and the impact on QoL of patients with
MS and refractory or intolerant to oral therapy overactive bladder (OAB) after botulinum toxin type A bladder injection.
Materials and Methods
Retrospective study with six-months follow-up of patients with MS diagnosis and a refractory or intolerable to oral drugs OAB
treated with botulinum toxin injections. All patients completed urological evaluation and a QoL questionnaire prior to the injection,
3 and 6-months after. Evaluation of the urodynamics tests prior and 3-months post injection was made.
Outcomes
Sixteen patients were treated. The QoL questionnaire showed progressive improvement 3 and 6-months after the injection. There
was decrease in the number of daily voids urination and in the urinary incontinence episodes. There was an upgrade in the bladder
capacity from 191 to 338 ml average (p 0.0004) and 75% evidenced disappearance of detrusor overactivity (p 0.0005). Thirteen (13)
patients (81.25%) made spontaneous urination with post-voiding residue <100 ml after injection. Three (3) episodes of urinary
tract infection were evidenced.
Conclusion
Botulinum toxin generates a positive impact on the QoL of patients with neurogenic OAB with MS.