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Title: | Botox rechallenge-An additional tool in the management of an incompletely emptying bladder and inadequate overactive symptom control following sacral neuromodulation. | Austin Authors: | Timm, Brennan ;Jayarajan, Jyotsna ;Chan, Garson ;Bolton, Damien M | Affiliation: | Urology North Eastern Urology, Heidelberg, Victoria, Australia |
Issue Date: | Jan-2021 | Date: | 2020-06-16 | Publication information: | Lower Urinary Tract Symptoms 2021; 13(1): 194-197 | Abstract: | Two female patients aged 70 and 72 with video-urodynamics-confirmed detrusor overactivity and detrusor underactivity (DO-DU) were treated. Patients were refractory to medical therapies and had previously failed intravesical botulinum toxin type A (BoNT-A) at other centers secondary to urinary retention and difficulty with self-catheterization. Placement of an Interstim II device (Medtronic, Minneapolis, Minnesota) for sacral neuromodulation (SNM) as alternative third-line treatment partially improved overactive bladder (OAB) symptoms while significantly improving voiding symptoms. Postvoid residual (PVR) of patients improved from a median of 118 mL (110-125 mL) to 20 mL (18-26 mL) and 213 mL (195-230 mL) to 70 mL (60-73 mL), respectively. Addition of medical therapies post SNM failed to modify OAB symptoms further and a rechallenge with dose-reduced BoNT-A was undertaken.OAB symptoms were significantly improved by addition of BoNT-A, while urinary retention was avoided (median PVR post BoNT-A 38 mL [34-40 mL] and 185 mL [150-205 mL], respectively). Reduction in incontinence pad use as well as resolution of nighttime incontinence in both patients and daytime incontinence in one patient was achieved. DO-DU patients treated by SNM who have improved bladder emptying (PVR <100 mL) but incomplete resolution of OAB symptoms should be trialed on adjunct medical therapies to improve OAB symptoms. If OAB symptoms are still inadequately controlled, consideration of a rechallenge with BoNT-A, particularly with dose reduction, appears to be efficacious and avoids symptomatic retention in this challenging cohort. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/27732 | DOI: | 10.1111/luts.12332 | ORCID: | 0000-0001-6195-3364 0000-0002-2241-6635 |
Journal: | Lower Urinary Tract Symptoms | PubMed URL: | 32548938 | Type: | Journal Article | Subjects: | BoNT-A Botox DO-DU OAB UUI acute urinary retention overactive bladder |
Appears in Collections: | Journal articles |
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