Five years follow-up study and failures analysis of Botulinum toxin repeated injections to treat neurogenic detrusor overactivity

Introduction: The aim of this work was to follow prospectively a cohort of patients 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 patients suffering from neurogenic OAB received a detrusor injection of 300 units of Botox™ (ALLERGAN, Irvine, CA) 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 patients of 31 (54.8%) were still injected, it means 60.7% of the primary responders. Eleven patients had left up the treatment, after at least one effective injection. We identified three reasons of surrender: echapment of treatment for two patients of 11 (7.1%); cessation of self catheterize for six patients of 11 (54.6%) and the surrender of the treatment without clinical or urodynamical failure, for three patients of 11 (27.3%). Although the cessation of self catheterize was more frequent for patients suffering from multiple sclerosis, no predictive factor of surrender was statically significant.

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.