The Role of Botulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in MS Patients
Keywords:
Overactive bladder, Multiple Sclerosis, Botulinum toxinAbstract
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.
References
Multiple Sclerosis International Federation. Atlas of MS 2013: mapping multiple sclerosis around the world. 2013. Web site. http://www.msif.org/wp-content/uploads/2014/09/Atlas-of-MS.pdf. Accessed April 15, 2020.
Nortvedt MW, Riise T, Frugård J, Mohn J, Bakke A, Skår AB, et al. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler. 2007; 13(1): 106-112. doi: 10.1177/1352458506071210
Stoffel JT. Contemporary management of the neurogenic bladder for multiple sclerosis patients. Urol Clin North Am. 2010; 37(4): 547-557. doi: 10.1016/j.ucl.2010.06.003
de Sèze M, Ruffion A, Denys P, Joseph PA, Perrouin-Verbe B, GENULF. The neurogenic bladder in multiple sclerosis: Review of the literature and proposal of management guidelines. Mult Scler. 2007; 13(7): 915-928. doi: 10.1177/1352458506075651
Akkoç Y, Ersöz M, Yüceyar N, Tunç H, Köklü K, Yoldaş TK, et al. Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment. J Spinal Cord Med. 2016; 39(2): 229-233. doi: 10.1179/2045772315Y.0000000021
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology. 2003; 61: 37-49. doi: 10.1016/s0090-4295(02)02243-4
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010; 21(1): 5-26. doi: 10.1007/s00192-009-0976-9
Kalsi V, Fowler C. Therapy insight: Bladder dysfunction associated with multiple sclerosis. Nat Clin Pract Urol. 2005; 2(10): 492-501. doi: 10.1038/ncpuro0323
Buser N, Ivic S, Kessler TM, Kessels AGH, Bachmann LM. Efficacy and adverse events of antimuscarinics for reating overactive bladder: Network meta-analyses. Eur Urol. 2012; 62(6): 1040-60. doi: 10.1016/j.eururo.2012.08.060
Potenziani BJC. Vejiga hiperactiva. Actualización 2005, CD Educación Médica Continua. Lithomedia Mayo. 2005.
Chancellor MB, Anderson RU, Boone TB. Pharmacotherapy for neurogenic detrusor overactivity. Am J Phys Med Rehabil. 2006; 85: 536-545. doi: 10.1097/01.phm.0000219229.92056.c2
De Ridder D, Ost D, Van der Aa F, Stagnaro M, Beneton C, Gross-Paju K, et al. Conservative bladder management in advanced multiple sclerosis. Mult Scler. 2005; 11: 694-699. doi: 10.1191/1352458505ms1237oa
Nicholas RS, Friede T, Hollis S, Young CA. Anticholinergics for urinary symptoms in multiple sclerosis. Cochrane Database Syst Rev. 2009; (1): CD004193. doi: 10.1002/14651858.CD004193.pub2
Madhuvrata P, Singh M, Hasafa Z, Abdel-Fattah M. Anticholinergic drugs for adult neurogenic detrusor overactivity: A systematic review and metaanalysis. Eur Urol. 2012; 62: 816-830. doi: 10.1016/j.eururo.2012.02.036
Zonić-Imamović M, Imamović S, Čičkušić A, Delalić A, Hodžić R, Imamović M, et al. Effects of treating an overactive urinary bladder in patients with multiple sclerosis. Acta Med Acad. 2019; 48(3): 271-277. doi: 10.5644/ama2006-124.267
Schurch B, de Sèze M, Denys P, Chartier-Kastler E, Haab F, Everaert K, Plante P, et al. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6 month study. J Urol. 2005; 174: 196-200. doi: 10.1097/01.ju.0000162035.73977.1c
Ehren I, Volz D, Farrelly E, Berglund L, Brundin L, Hultling C, et al. Efficacy and impact of botulinum toxin A on quality of life in patients with neurogenic detrusor overactivity. Scand J Urol Nephrol. 2007; 41: 335-340. doi: 10.1080/00365590601068835
Ginsberg D, Gousse A, Keppenne V, Sievert K-D, Thompson C, Wayne Lam, et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol. 2012; 187: 2131-2139. doi: 10.1016/j. juro.2012.01.125
Mangera A, Andersson K-E, Apostolidis A, Chapple C, Dasgupta P, Giannantoni A, et al. Contemporary management of lower urinary tract disease with botulinum toxin A: A Submit your article to this journal | https://openventio.org/submit-manuscript/ Villalba Bachur Roberto F et al systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol. 2011; 60: 784-795. doi: 10.1016/j. eururo.2011.07.001
Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, et al. Efficacy and safety of onabotulinumtoxin A in patients with urinary incontinence due to neurogenic detrusor overactivity: A randomised, double-blind, placebo-controlled trial. Eur Urol. 2011; 60: 742-750. doi: 10.1016/j.eururo.2011.07.002
Ginsberg D, Cruz F, Herschorn S, Gousse A, Keppenne V, Aliotta P, et al. OnabotulinumtoxinA is effective in patients with urinary incontinence due to neurogenic detrusor overactivityregardless of concomitant anticholinergic use or neurologic etiology. Adv Ther. 2013; 30: 819-833. doi: 10.1007/s12325-013-0054-z
Tullman M, Chartier-Kastler E, Kohan A, Keppenne V, Brucker BM, Egerdie B, et al. OnabotulinumtoxinA improves urinary symptoms in noncatheterizing patients with MS. Neurology. 2018; 91(7): e657-e665. doi: 10.1212/WNL.0000000000005991
Amundsen CL, Richter HE, Menefee SA, Komesu YM, Arya LA, Gregory WT, et al. OnabotulinumtoxinA vs sacral neuromodulation on refractory urgency urinary incontinence in women: A randomized clinical trial. JAMA. 2016; 316(13): 1366- 1374. doi: 10.1001/jama.2016.14617
Mehnert U, Birzele J, Reuter, K, Schurch B. The effect of botulinum toxin type a on overactive bladder symptoms in patients with multiple sclerosis: A pilot study. J Urol. 2010; 184: 1011-1016. doi: 10.1016/j.juro.2010.05.035
Rovner E, Dmochowski R, Chapple C, Thompson C, Lam W, Haag-Molkenteller C. OnabotulinumtoxinA improves urodynamic outcomes in patients with neurogenic detrusor overactivity. Neurourol Urodyn. 2013; 32(8): 1109-1115. doi: 10.1002/nau.22376
Baron M, Peyronnet B, Aublé A, Hascoet J, Castel-Lacanal E, Miget G, et al. Long-term discontinuation of botulinum toxin A intradetrusor injections for neurogenic detrusor overactivity: A multicenter study. J Urol. 2019; 201(4): 769-776. doi: 10.1016/j. juro.2018.10.012
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