Téma: 

Application of botulinumtoxin into detrusor in patients with neurogenic bladder – which is the optimal indication group of patients?

Jan Krhut, Josef Kopecký, Pavel Hradílek

Introduction: Neurogenic dysfunction of lower urinary tract (LUT) markedly decreases the quality of life of patients and it can markedly threaten the function of upper urinary tract in some cases. Routine therapy of the first choice is administration of anticholinergics in combination with intermittent catheterization. However, this therapy can be in some patients ineffective. These patients used to be treated mostly by surgical therapy, currently therapy with botulinumtoxin (btx) is offered. The aim of the study is to evaluate and compare results of btx therapy in patients with neurogenic urinary bladder of various aetiologies and determine the optimal indication group. Patients and methods: The set includes total number of 42 patients with neurogenic dysfunctions of LUT treated by btx, 29 men and 13 women, mean age is 31.3 (8 - 59) yrs. Twenty nine patients suffered from traumatic spinal cord lesions (TML), 9 patients suffered from multiple sclerosis (DS) and in 4 patients dysfunction of LUT developed on base of congenital dysraphism (MMC). Therapy of the first choice failed in all patients. In all cases Dysport® was applied in doses of 1000 UI for one application in adults. Btx was administered during a short endoscopic procedure using a flexible needle into 40 places of the detrusor. Subjective satisfaction, urodynamic parameters and duration of effect in particular groups were evaluated. Results: In the group of patients with TLM subjective satisfaction with the results of treatment was achieved in 22 (75.9 %) patients. In 17 (62.1 %) patients full continence was achieved, in 8 (27.6 %) daily continence was achieved. Increase of cystometric capacity was achieved from 194.8 to 317 ml and decrease of detrusor pressure from 76.2 to 33.8 cmH2O. Duration of treatment effects was 6.6 (3 - 9) months. In a partial group of patients with RS subjective satisfaction with results of treatment was achieved in all 9 patients (100 %). Full continence was also achieved in all 9 (100 %) patients. Increase of cystometric capacity from 178.2 to 462.2 ml and decrease of detruzor pressure from 52.2 to 10.4 cmH2O. Duration of treatment effects was 12.3 (8 - 15) months. In a partial group of patients with MMC subjective satisfaction with results of treatment was achieved in 3 patients (75 %). Full continence was achieved in 2 (50 %) patients, and in 1 patient daily continence was achieved. Increase of cystometric capacity from 221.7 to 318.5 ml and decrease of detrusor pressure from 58.5 to 23.3 cmH2O. Duration of treatment effects was 8.25 (7 - 9) months. Conclusion: The best results were achieved in the group of patients with RS who on the basis of our experience belong to the best indication group for this type of therapy.

Ročník 2007  Témy časopisu Clinical urology 3 / 2007

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