Practical Aspects of Botulinum Toxin-A Treatment in Patients With Overactive Bladder Syndrome
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Intravesical onabotulinumtoxinA (BoNT-A) injection is an effective treatment for overactive bladder syndrome (OAB) that is refractory to antimuscarinics. An injectable dose of 100 U has been suggested to achieve the optimal balance of benefit and safety in patients with OAB. BoNT-A (total volume of 10 mL) was administered as evenly distributed intradetrusor injections (5 U) across 20 sites approximately 1 cm apart (0.5 mL per site) using a flexible or rigid cystoscope. Treatment with BoNT-A was generally well tolerated by most patients, and most treatment-related adverse events were localized to the urinary tract. The prevalence of OAB increases with age, and elderly patients are more vulnerable to complications. The short-term efficacy of intravesical BoNT-A injection for refractory OAB with no treatment-related complications in the elderly population has been documented. Frail elderly patients can experience the same treatment results, such as significantly improved urgent urinary incontinence and quality of life, as young and nonfrail elderly patients with 100-U BoNT-A injections. However, increased risk of larger postvoid residual (PVR) urine and lower long-term success rates were noted in frail elderly patients; around 11% had acute urinary retention, while 60% had PVR urine volume >150 mL after treatment. In addition, intravesical injection of BoNT-A effectively decreased urgency symptoms in elderly patients with OAB and central nervous system lesions. The adverse effects were acceptable, while the long-term effects were comparable to those in patients with OAB without central nervous system lesions. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization in this vulnerable population requires careful evaluation before treatment with intravesical BoNT-A. In conclusion, the current findings indicate that intravesical BoNT-A is an effective and safe treatment for OAB in elderly patients.
Abstract
Intravesical onabotulinumtoxinA (BoNT-A) injection is an effective treatment for overactive bladder syndrome (OAB) that is refractory to antimuscarinics. An injectable dose of 100 U has been suggested to achieve the optimal balance of benefit and safety in patients with OAB. BoNT-A (total volume of 10 mL) was administered as evenly distributed intradetrusor injections (5 U) across 20 sites approximately 1 cm apart (0.5 mL per site) using a flexible or rigid cystoscope. Treatment with BoNT-A was generally well tolerated by most patients, and most treatment-related adverse events were localized to the urinary tract. The prevalence of OAB increases with age, and elderly patients are more vulnerable to complications. The short-term efficacy of intravesical BoNT-A injection for refractory OAB with no treatment-related complications in the elderly population has been documented. Frail elderly patients can experience the same treatment results, such as significantly improved urgent urinary incontinence and quality of life, as young and nonfrail elderly patients with 100-U BoNT-A injections. However, increased risk of larger postvoid residual (PVR) urine and lower long-term success rates were noted in frail elderly patients; around 11% had acute urinary retention, while 60% had PVR urine volume >150 mL after treatment. In addition, intravesical injection of BoNT-A effectively decreased urgency symptoms in elderly patients with OAB and central nervous system lesions. The adverse effects were acceptable, while the long-term effects were comparable to those in patients with OAB without central nervous system lesions. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization in this vulnerable population requires careful evaluation before treatment with intravesical BoNT-A. In conclusion, the current findings indicate that intravesical BoNT-A is an effective and safe treatment for OAB in elderly patients.
참고문헌 (35)
- Gormley EA, "Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA", SUFU guideline, 2012, pp.188(6 Suppl), 2455~2463
- Oelke M, "EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction", Eur Urol, 64, pp.118~140 (2013)
- Wagg A, "Persistence with prescribed antimuscarinic therapy for overactive bladder: a UK experience", BJU Int, 110, pp.1767~1774 (2012)
- Chancellor MB, "Long-term patterns of use and treatment failure with anticholinergic agents for overactive bladder", Clin Ther, 35, pp.1744~1751 (2013)
- Sahai A, "Improvement in quality of life after botulinum toxin-A injections for idiopathic detrusor overactivity: results from a randomized double-blind placebo-controlled trial", BJU Int, 103, pp.1509~1515 (2009)
- Fowler CJ, "OnabotulinumtoxinA improves health-related quality of life in patients with urinary incontinence due to idiopathic overactive bladder: a 36-week, double-blind, placebo-controlled, randomized, dose-ranging trial", Eur Urol, 62, pp.148~157 (2012)
- Dmochowski R, "Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial", J Urol, 184, pp.2416~2422 (2010)
- Denys P, "Efficacy and safety of low doses of onabotulinumtoxinA for the treatment of refractory idiopathic overactive bladder: a multicentre, double-blind, randomised, placebo-controlled doseranging study", Eur Urol, 61, pp.520~529 (2012)
- Chapple C, "OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial", Eur Urol, 64, pp.249~256 (2013)
- Nitti VW, "OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial", J Urol, 189, pp.2186~2193 (2013)
- Rovner E, "Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder", Neurourol Urodyn, 30, pp.556~562 (2011)
- Kuo HC, "Adverse events of intravesical botulinum toxin a injections for idiopathic detrusor overactivity: risk factors and influence on treatment outcome", Eur Urol, 58, pp.919~926 (2010)
- Osborn DJ, "Urinary retention rates after intravesical onabotulinumtoxinA injection for idiopathic overactive bladder in clinical practice and predictors of this outcome", Neurourol Urodyn, 34, pp.675~678 (2015)
- Cox L, "OnabotulinumtoxinA for the treatment of overactive bladder", Res Rep Urol, 6, pp.79~89 (2014)
- Rovner E, "Chapter 6: practical aspects of administration of onabotulinumtoxinA", Neurourol Urodyn, 33(Suppl 3), pp.S32~S37 (2014)
- Kuo HC, "Bladder base", trigone injection is safe and as effective as bladder body injection of onabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics, 2011, pp.30, 1242~1248
- Manecksha RP, "Prospective randomised controlled trial comparing trigone-sparing versus trigone-including intradetrusor injection of abobotulinumtoxinA for refractory idiopathic detrusor overactivity", Eur Urol, 61, pp.928~935 (2012)
- Coelho A, "Distribution of the high-affinity binding site and intracellular target of botulinum toxin type A in the human bladder", Eur Urol, 57, pp.884~890 (2010)
- "Different number of intravesical onabotulinumtoxinA injections for patients with refractory detrusor overactivity do not affect treatment outcome: a prospective randomized comparative study"[URL]
- Kuo HC, "Comparison of effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity", J Urol, 178(4 Pt 1), pp.1359~1363 (2007)
- Krhut J, "Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study", Spinal Cord, 50, pp.904~907 (2012)
- Sievert KD, "OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder", Int J Clin Pract, 68, pp.1246~1256 (2014)
- Makovey I, "Botulinum toxin outcomes for idiopathic overactive bladder stratified by indication: lack of anticholinergic efficacy versus intolerability", Neurourol Urodyn, 30, pp.1538~1540 (2011)
- Cui Y, "The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: a systematic review and meta-analysis", Neurourol Urodyn, 34, pp.413~419 (2015)
- Mangera A, "An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders", Eur Urol, 65, pp.981~990 (2014)
- "Botox 100 Unit Summary of Product Characteristics"[URL]
- Cruz F, "Chapter 5: clinical data in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB)", Neurourol Urodyn, 33(Suppl 3), pp.S26~S31 (2014)
- Dowson C, "Repeated botulinum toxin type A injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates", Eur Urol, 61, pp.834~839 (2012)
- Mohee A, "Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB)", BJU Int, 111, pp.106~113 (2013)
- Oefelein MG, "Safety and tolerability profiles of anticholinergic agents used for the treatment of overactive bladder", Drug Saf, 34, pp.733~754 (2011)
- White WM, "Short-term efficacy of botulinum toxin a for refractory overactive bladder in the elderly population", J Urol, 180, pp.2522~2526 (2008)
- Liao CH, "Increased risk of large post-void residual urine and decreased long-term success rate after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity", J Urol, 189, pp.1804~1810 (2013)
- Wang CC, "Diabetes mellitus does not affect the efficacy and safety of intravesical onabotulinumtoxina injection in patients with refractory detrusor overactivity", Neurourol Urodyn, 33, pp.1235~1239 (2014)
- Andersson KE, "Mechanisms of Disease: central nervous system involvement in overactive bladder syndrome", Nat Clin Pract Urol, 1, pp.103~108 (2004)
- Jiang YH, "Efficacy and safety of intravesical onabotulinumtoxinA injection on elderly patients with chronic central nervous system lesions and overactive bladder", PLoS One, 9, pp.e105989~ (2014)