THE EFFECT OF INTRAVESICAL ONABOTULINUM TOXIN A TREATMENT ON QUALITY OF LIFE IN PATIENTS WITH OVERACTIVE BLADDER

Abstract

Objective: Overactive bladder (OAB) syndrome is common in women and negatively affects their quality of life. Our study aimed to evaluate the effect of intravesical onabotulinum toxin A injection on quality of life and urinary symptoms in patients with treatment resistant OAB syndrome. Material and Method: The treatment records of 20 patients with treatment-resistant OAB were reviewed. The patients were injected with a 1:1 solution of saline and 100 units of onabotulinum toxin A at 20 different points on the body, avoiding the bladder trigon. The following survey instruments were used to determine the patient’s quality of life before and after treatment: the King’s Health Questionnaire (KHQ), the short-form Urodistress Inventory (UDI 6), the short-form Incontinence Impact Questionnaire (IIQ 7), the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ FLUTS), the Female Sexual Function Index (FSFI), and the Pelvic Organ Prolapse/Urinary Incontinence Inquiry form (PISQ-12). The pre-and post-treatment results of the questionnaires were then evaluated. Result: The uroflowmetry parameters indicated that the patients’ maximum urine flow rate decreased significantly after treatment, as did their KHQ scores on all but one item. Evaluation of their FSFI scores indicated no significant change after treatment; however, the other quality of life questionnaires used (UDI-6, IIQ-7, ICIQ-FLUTS, and PISQ-12) revealed significant decreases, indicating an improvement in quality of life. Conclusion: When the patients’ short-term results were evaluated, it was found that this therapy reduced their symptoms and complaints, thus improving their quality of life. Although none of the patients in the sample group experienced complications, in some cases catheterization is necessary due to infection and increased residual urine. Intravesical onabotulinum toxin A injection is a cheap and easy-to-administer treatment for OAB that has not responded to other treatments and does not cause serious side effects.

Keywords

• Overactive bladder
• Onabotulinumtoxin A
• Urinary Retention
• Urgency

Project Number

Yok

İNTRAVEZİKAL ONABOTULİNUM TOKSİN A TEDAVİSİNİN AŞIRI AKTİF MESANE HASTALARINDA YAŞAM KALİTESİ ÜZERİNE ETKİSİ

Abstract

Amaç: Aşırı aktif mesane (AAM), kadınlarda oldukça sık görülen ve hayat kalitesini olumsuz etkileyen bir sendromdur. Çalışmamızın amacı; tedaviye dirençli AAM sendromu olan hastalarda intravezikal onabotulinum toksin A enjeksiyonunun hastaların hayat kalitesine ve üriner semptomlarına olan etkisini değerlendirmektir. Gereç ve Yöntem: Çalışmaya medikal tedaviye dirençli toplam 20 hasta dahil edildi. Hastalara 1:1 oranda salin ile sulandırılıp 100 Ünite onabotulinum toksin A kullanılarak 20 farklı noktaya, mesane trigonundan kaçınılarak enjeksiyon yapılmıştır. Hastaların yaşam kalitelerini belirlemek için kullanılan “King Sağlık Anketi (KHQ), Ürogenital Distres Envanteri kısa formu (UDI 6), İnkontinans Etki Anketi kısa formu (IIQ 7), ICIQ-FLUTS, Kadın Cinsel Fonksiyon Endeksi formu (FSFI), Pelvik Organ Prolapsusu/ Üriner İnkontinans Sorgulama formu (PISQ-12)” anketlerin tedavi öncesi ve tedavi sonrası sonuçları değerlendirilmiştir. Bulgular: Tedavi öncesi ve sonrası üroflowmetri parametrelerinden maksimum idrar akım hızında anlamlı azalma izlendi. Tedavi öncesi ve sonrası yapılan KHQ skorlarının değerlendirilmesinde kişiler arası ilişkiler dışında tüm skorlarda anlamlı azalma izlendi. Tedavi öncesi ve sonrası FSFI skorları değerlendirildiğinde anlamlı bir değişiklik olmadığı izlendi. Ancak, diğer yaşam kalite anketleri olan UDI-6, IIQ-7, ICIQ-FLUTS ve PISQ-12’de anlamlı bir azalma olduğu ve yaşam kalitesinde olumlu değişim olduğu izlendi. Sonuç: Medikal tedaviye dirençli aşırı aktif mesane sendromu olan hastalarda; intravezikal onabotulinum toksin A enjeksiyonunun kısa dönem sonuçları değerlendirildiğinde hastaların semptom, şikayetlerini azaltmış ve hastaların hayat kalitelerini olumlu yönde arttırmıştır. Bizim hasta grubumuzda komplikasyon gelişmemiş olsa da enfeksiyon ve rezidü idrar artışına bağlı kateterizasyon görülebilmektedir. Medikal tedaviye yanıt alınmayan AAM tedavisinde intravezikal onabotulinum toksin A enjeksiyonu ucuz, kolay uygulanabilir ve ciddi yan etkisi olmayan bir tedavi seçeneği olduğu düşünmekteyiz.

Keywords

• Aşırı aktif mesane
• onabotulinum toksin A
• üriner retansiyon
• aciliyet hissi

Supporting Institution

Yok

Project Number

Yok

References

1. 1. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol 2003;20(6):327-36. [CrossRef] google scholar
2. 2. Hsiao SM, Lin HH, Kuo HC. Factors associated with therapeutic efficacy of intravesical onabotulinum toxin A injection for overactive bladder syndrome. PLoS One 2016;11(1):e0147137. [CrossRef] google scholar
3. 3. Amundsen CL, Richter HE, Menefee SA, Komesu YM, Arya LA, Gregory WT, et al. Onabotulinum toxin A vs sacral neuromodulation on refractory urgency urinary incontinence in women: a randomized clinical trial. JAMA 2016;316(13):1366-74. [CrossRef] google scholar
4. 4. Apostolidis A. Pharmacotherapy for overactive bladder: minimally invasive treatment—botulinum toxins. Expert Opin Pharmacother 2011;12(7):1029-39. [CrossRef] google scholar
5. 5. Chancellor MB, Patel V, Leng WW, Shenot PJ, Lam W, Globe DR, et al. Onabotulinum toxin A improves quality of life in patients with neurogenic detrusor overactivity. Neurology 2013;81(9):841-8. [CrossRef] google scholar
6. 6. Crystle CD, Charme LS, Copeland WE. Q-tip test in stress urinary incontinence. Obstet Gynecol 1971;38(2):313-5. google scholar
7. 7. Liapis A, Bakas P, Christopoulos P, Giner M, Creatsas G. Tension-free vaginal tape for elderly women with stress urinary incontinence. Int J Gynaecol Obstet 2006;92(1):48-51. [CrossRef] google scholar
8. 8. Sutherst J, Brown M, Shawer M. Assessing the severity of urinary incontinence in women by weighing perineal pads. Lancet 1981;1(8230):1128-30. [CrossRef] google scholar

9. 9. Raju R, Linder BJ. Evaluation and treatment of overactive bladder in women. Mayo Clin Proc 2020;95(2):370-7. [CrossRef] google scholar
10. 10. Walsh JB, Mills GL. Measurement of urinary loss in elderly incontinent patients: a simple and accurate method. Lancet 1981;1(8230):1130-1. [CrossRef] google scholar
11. 11. Hellstrom AL, Andersson K, Hjalmas K, Jodal U. Pad tests in children with incontinence. Scand J Urol Nephrol 1986;20(1):47-50. [CrossRef] google scholar
12. 12. Raju R, Linder BJ. Evaluation and treatment of overactive bladder in women. Mayo Clin Proc 2020;95(2):370-7. [CrossRef] google scholar
13. 13. Humburg J. Die Urinin kontinenz der Frau: Einführung in die diagnostik und therapie [Female urinary incontinence: diagnosis and treatment] Ther Umsch 2019;73(9):535-40. [CrossRef] google scholar
14. 14. Malde S, Apostilidis A, Selai C, Rahnama’i MS, Marcelissen T, Cardozo L, et al. Botulinum toxin A for refractory OAB and idiopathic urinary retention: can phenotyping improve outcome for patients: ICI-RS 2019? Neurourol Urodyn 2020;39(13):104-12. [CrossRef] google scholar
15. 15. Chen JL, Kuo HC. Clinical application of intravesical botulinum toxin type A for overactive bladder and interstitial cystitis. Investig Clin Urol 2020;61(1):S33-42. [CrossRef] google scholar
16. 16. Kim A, Lee KS, Jung R, Na S, Kim JC, Kim HG, et al. Health-related quality of life in patients with side effects after antimuscarinic treatment for overactive bladder. Low Urin Tract Symptoms 2017;9(3):171-5. [CrossRef] google scholar
17. 17. Chen LC, Kuo HC. Pathophysiology of refractory overactive bladder. Low Urin Tract Symptoms 2019;11(4):177-81. [CrossRef] google scholar
18. 18. Minassian VA, Drutz HP, Al-Badr A. urinary incontinence as a worldwide problem. Int J Gynaecol Obstet 2003;82(3):327-38. [CrossRef] google scholar
19. 19. Madhu C, Enki D, Drake MJ, Hashim H. The functional effects of cigarette smoking in women on the lower urinary tract. Urol Int 2015;95(4):478-82. [CrossRef] google scholar
20. 20. Cheung WW, Borawski D, Abulafia O, Vincent MT, Harel M, Bluth MH. Characterization of overactive bladder in women in a primary care setting. Open Access J Urol 2011;3:29-34. [CrossRef] google scholar
21. 21. Handa VL, Pierce CB, Munoz A, Blomquist JL. Longitudinal changes in overactive bladder and stress incontinence among parous women. Neurourol Urodyn 2015;34(4):356-61. [CrossRef] google scholar
22. 22. Parazzini F, Chiaffarino F, Lavezzari M, Giambanco V. Risk factors for stress, urge or mixed urinary incontinence in Italy. BJOG 2003;110(10):927-33. [CrossRef] google scholar
23. 23. Brown JS. Urinary incontinence: an important and underrecognized complication of type 2 diabetes mellitus. J Am Geriatrics Soc 2005;53(11):2028-9. [CrossRef] google scholar
24. 24. Palma T, Raimondi M, Souto S, Fozzatti C, Palma P, Riccetto C. Correlation between body mass index and overactive bladder symptoms in pre-menopausal women. Rev Assoc Med Bras (1992) 2014;60(2):111-7. [CrossRef] google scholar
25. 25. Herschorn S, Gajewski J, Ethans K, Corcos J, Carlson K, Bailly G, et al. Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. J Urol 2011;185(6):2229-35. [CrossRef] google scholar
26. 26. Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, et al. Efficacy and safety of onabotulinum toxin A for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol 2010;184(6):2416-22. [CrossRef] google scholar
27. 27. Hsieh PF, Chiu HC, Chen KC, Chang CH, Chou EC. Botulinum toxin A for the treatment of overactive bladder. Toxins (Basel) 2016;8(3):59. [CrossRef] google scholar
28. 28. Schulte-Baukloh H, Herholz J, Bigalke H, Miller K, Knispel HH. Results of a BoNT/A antibody study in children and adolescents after onabotulinum toxin A (Botox®) detrusor injection. Urol Int 2011;87(4):434-8. [CrossRef] google scholar
29. 29. Kalsi V, Apostolidis A, Popat R, Gonzales G, Fowler CJ, Dasgupta P. Quality of life changes in patients with neurogenic versus idiopathic detrusor overactivity after intradetrusor injections of botulinum neurotoxin type A and correlations with lower urinary tract symptoms and urodynamic changes. Eur Urol 2006;49(3):528-35. [CrossRef] google scholar
30. 30. Game X, Khan S, Panicker JN, Kalsi V, Dalton C, Elneil S, et al. Comparison of the impact on health-related quality of life of repeated detrusor injections of botulinum toxin in patients with idiopathic or neurogenic detrusor overactivity. BJU Int 2011;107(11):1786-92. [CrossRef] google scholar