Botulinum Toxin in the Treatment of Detrusor Overactivity in Woman Patients with Multiple Sclerosis

Czech version

Authors: J. Krhut ¹; R. Zachoval ²; P. Hradílek ³; O. Havránek ¹; O. Zapletalová ³
Authors‘ workplace: Urologické oddělení FN Ostrava ¹; Urologické oddělení 3. LF UK a FTNsP Praha ²; Neurologická klinika FN Ostrava ³
Published in: Cesk Slov Neurol N 2008; 71/104(4): 429-434
Category: Original Paper

Overview

Introduction:
Botulinum toxin A has been used with success in the therapy of both neurogenic and non-neurogenic detrusor overactivity in patients who do not respond to anticholinergic therapy. The goal of the study is to analyse the results of treatment of detrusor overactivity with botulinum toxin (btx) in a set of patients with multiple sclerosis (MS).

Patient set and method:
The set of patients consisted of a total of nine woman patients with multiple sclerosis (MS) and detrusor overactivity refractory to oral anticholinergic therapy. The patients were treated with 1,000 UI intradetrusor Dysport injection, and their bladders were emptied with intermittent catheterisation after treatment. After the application of btx, all oral anticholinergic drugs were withdrawn. The median age of the patient set was 41.6 years (from 31 to 52 years), the median of the EDSS value was 5.2 (3.5–7). Subjective satisfaction and quality of life prior to and three months after the application of btx was evaluated with the use of the King’s Health Questionnaire (KHQ), and the Incontinence – Quality of Life Questionnaire (I-QoL). Data from bladder diaries and urodynamic parametres were evaluated every three months while the effect of the therapy lasted.

Results:
The evaluation of the I-QoL index showed an increase from 16.7 (6.8–25.0) prior to therapy to 72.4 (46.4–93.2) three months after therapy. A significant reduction of the impact of the lower urinary tract dysfunctions on the quality of life three months after therapy was recorded in all sections of the KHQ questionnaire. The frequency of bladder emptying three months after therapy decreased from 19.4/24 hours to 6.8/24 hours, while the voided volume grew from 122.6 to 378.9 ml. Similar results were recorded 6, 9 and 12 months after therapy. Urodynamic measurements three months after therapy showed an increase in cystometric capacity from 175.4 to 450.6 ml, and a decrease in the maximum detrusor pressure from 52.2 cm H₂O to 10.4 cm H₂O. The improvement lasted for 6, 9 and 12 months after therapy. The duration of effect was 12.3 (10–15) months in the set.

Conclusion:
The application of botulinum toxin is an efficient method of treatment of neurogenic detrusor overactivity in woman patients with MS.

Key words:
multiple sclerosis – botulinum toxin – neurogenic bladder – detrusor overactivity

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