Clinical effectiveness of intradetrusor injections of botulinum toxin type a in dose 100 units in multiple sclerosis patients with neurogenic detrusor overactivity

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Abstract

Intravesical injections of botunulinum toxin type A (BTA) demonstrate good results in treatment of detrusor overactivity symptoms in patients with neurogenic low urinary tract dysfunction (NLUTD) when use in recommended doses of 200 and 300 Units. In clinical practice a government insurance dose not cover the price for the 200 BTA Units and only 100 Units may be injected in patients with neurogenic and nonneurogenic detrusor overactivity.

The aim was to evaluate the efficiency of intradetrusor injections of BTA in patients with NLUTD.

Materials and methods. The study included 28 MS patients with resistant to medical treatment neurogenic detrusor overactivity. All patients received intradetrusor injections of 100 BTA Units. The results were assessed after 1, 3 and 6 months after procedure.

Results. Clinical improvement had been achieved in all 28 patients. According to the urodynamic studies three months after BTA injections maximal cystometric capacity increased by 119.9 ± 37.6% (p < 0,05), volume at first detrusor involuntary contraction increased by 74.8 ± 21.4% (p < 0,05), maximal detrusor pressure at involuntary contraction decreased by 53.5 ± 29.7% (p < 0,05). The NBSS total score decreased from 38.04 ± 14.27 to 29.06 ± 14.46 (p = 0,000), mainly because of questions about incontinence and urgency. SF-Qualiveen total score turned from 2.32 ± 0.70 to 1.61 ± 0.85 (p = 0.000). Before procedure 2 patients performed intermittent catheterization, 4 patients catheterized after BTA injections.

Conclusion. Intradetrusor injection of 100 BTA Units in MS patients with NLUTD resulted in improvement of urodynamic parameters followed by reduction of clinical symptoms and life quality improvement for 6 months of observation. Using of BTA low dose didn’t provide a total abortion of neurogenic detrusor overactivity symptoms but led to the starting of IC only in 2 patients.

About the authors

Еkaterina S. Filippova

Urals State Medical University of the Ministry of Healthcare of the Russian Federation; Sverdlovsk Regional Clinical Hospital No. 1

Author for correspondence.
Email: filippova.cat@yandex.ru
ORCID iD: 0000-0003-3065-3953
SPIN-code: 6364-8190

Candidate of Medical Sciences, Associate Professor of the Department of Urology; Urologist

Russian Federation, Ekaterinburg

Igor V. Bazhenov

Urals State Medical University of the Ministry of Healthcare of the Russian Federation; Sverdlovsk Regional Clinical Hospital No. 1

Email: biv@okb1.ru
ORCID iD: 0000-0003-1745-700X
SPIN-code: 7269-7282

Doctor of Medical Sciences, Professor of the Department of Urology; Head of the Urological Unit

Russian Federation, Ekaterinburg

Aleksandr V. Zyrjanov

Urals State Medical University of the Ministry of Healthcare of the Russian Federation; Sverdlovsk Regional Clinical Hospital No. 1

Email: zav1965@mail.ru
ORCID iD: 0000-0001-8105-7233
SPIN-code: 6193-4204

Doctor of Medical Sciences, Professor. Chairman of the Department of Urology; Head of the Regional Urological Center of the Sverdlovsk Regional Clinical Hospital No. 1

Russian Federation, Ekaterinburg

Vladimir N. Zhuravlev

Urals State Medical University of the Ministry of Healthcare of the Russian Federation

Email: zhuravlev@okb1.ru
SPIN-code: 7045-1956

Doctor of Medical Sciences, Professor

Russian Federation, Ekaterinburg

Igor V. Borzunov

Urals State Medical University of the Ministry of Healthcare of the Russian Federation

Email: ivborzunov@e1.ru
ORCID iD: 0000-0002-9827-8451
SPIN-code: 5502-4009

Doctor of Medical Sciences, Professor of the Department of Urology

Russian Federation, Ekaterinburg

Gennadiy S. Ustinov

Urals State Medical University of the Ministry of Healthcare of the Russian Federation

Email: GennadiyUstinov@mail.ru
ORCID iD: 0000-0002-4263-4568
SPIN-code: 8423-8060

Student

Russian Federation, Ekaterinburg

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2. Fig. 1. Cystometry of patient F., 64 years old, suffering from multiple sclerosis with neurogenic detrusor overactivity. Urodynamic signs of detrusor hyperactivity. First involuntary detrusor contraction is accompanied by urge urinary incontinence. V1IDC = 19.7 ml, PdetmaxIDC = 63.5 cm H2O

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3. Fig. 2. Cystometry of patient F., 64 years old, suffering from multiple sclerosis with neurogenic detrusor overactivity in 3 months after botulinum therapy. The volume of filling at the first involuntary detrusor contraction is 264 ml, urge urinary incontinence is absent

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4. Fig. 3. Change in the urodynamic parameters of patients with neurogenic detrusor hyperactivity in 3 months after botulinum therapy at a dose of 100 Units, n = 28 (MCC – maximal cystometric capacity; V1IDC – volume at first involuntary detrusor contraction; * p < 0.05 with a value before treatment)

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5. Fig. 4. Change in the maximum detrusor pressure at first involuntary contraction of patients with neurogenic detrusor hyperactivity 3 months after botulinum therapy at a dose of 100 Units, n = 28; * p < 0.05 with a value before treatment

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6. Fig. 5. The values of the indicators Neurogenic Bladder Symptom Score (NBSS) in patients with neurogenic detrusor overactivity before and after 1, 3 and 6 months after intradetrusor injection of BTA, points (n = 28)

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Copyright (c) 2020 Filippova Е.S., Bazhenov I.V., Zyrjanov A.V., Zhuravlev V.N., Borzunov I.V., Ustinov G.S.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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