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 (TM) (ALLERGAN, Irvine, CA) and were followed prospectively (median 5 years). They were evaluated by voiding diary, Qualiveen (TM) 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. (C) 2012 Elsevier Masson SAS. All rights reserved.