Int Neurourol J.  2019 Sep;23(3):240-248. 10.5213/inj.1938098.049.

Assessment of Anticholinergic Use After Fading of BTX-A Effects in Refractory Idiopathic Overactive Bladder: A Prospective Blinded Randomized Trial

• Elbaset MA
• Taha DE
• El-Hefnawy AS
• Zahran MH
• Shokeir AA

• KMID: 2460737
• DOI: http://doi.org/10.5213/inj.1938098.049

Abstract

PURPOSE
To evaluate the efficacy and safety of re-treatment with anticholinergics on refractory idiopathic overactive bladder (OAB) previously treated with intravesical botulinum neurotoxin type A (BTX-A) injections.
METHODS
One hundred patients were initially managed by intravesical injections of 100 IU of BTX-A. After the effects of BTX-A faded, patients were randomized into 2 groups: group A patients received solifenacin (10 mg) for 12 weeks (study group), while group B patients received placebo treatment for 12 weeks (control group), then subsequently received solifenacin (10 mg) for another 6 weeks. All patients underwent preoperative urodynamic testing. Patients were asked to complete the validated overactive bladder symptoms score (OABSS) and incontinence quality of life (I-QoL) instruments after the effects of intravesical BTX-A faded and at 12 weeks of follow-up. Univariate and multivariate analyses of the factors affecting treatment response were conducted.
RESULTS
At 12 weeks of follow-up, in group A, all OABSS items, including the total score, had improved significantly (P<0.0001). Group A had lower frequency and amplitude of detrusor overactivity and detrusor leak point pressure (P<0.0001, P=0.03, and P=0.01, respectively). Cystometric capacity also increased significantly (P=0.007), as did all I-QoL parameters. In a comparison of patients with failed treatment and patients with successful treatment, female sex, repeated intravesical BTX-A injections, and increased bladder capacity were statistically significant (P=0.001, P=0.0001, and P=0.002, respectively). Repeated intravesical BTX-A injections and increased bladder capacity were independent factors predicting treatment success.
CONCLUSIONS
In patients with refractory idiopathic OAB, reuse of anticholinergics could be an effective treatment option in patients after the effects of BTX-A fade. Repeated intravesical BTX-A injections and increased cystometric capacity could affect treatment response.

Keyword

Urinary bladder, overactive; Botulinum toxins, type A; Quality of life; Solifenacin

MeSH Terms

Administration, Intravesical
Botulinum Toxins, Type A
Cholinergic Antagonists
Female
Follow-Up Studies
Humans
Multivariate Analysis
Prospective Studies*
Quality of Life
Solifenacin Succinate
Urinary Bladder
Urinary Bladder, Overactive*
Urodynamics
Botulinum Toxins, Type A
Cholinergic Antagonists
Solifenacin Succinate