Aims of this study were to assess the long-term outcomes of detrusor injection of OnabotulinumtoxinA (Botox® injection) associated with clean intermittent-catheterization (CIC) for the treatment of neurogenic detrusor overactivity (NDO) and to identify risk factors for failure.
Neurogenic detrusor overactivity (NDO) remains a major concern for patients with neurological diseases. Fifty to eighty percent of patients with multiple sclerosis (MS) or traumatic spinal cord injury (SCI) and more than 60% of patients with myelomeningocele suffer from urinary incontinence episodes (UI) due to NDO. NDO is characterized by involuntary detrusor contractions during the filling phase, leading to leakage and increase in bladder pressure, which can, precipitate renal failure. Detrusor injection of OnabotulinumtoxinA (Botox®), is licensed worldwide and recommended as a second line therapy for the treatment of urinary incontinence due to NDO after failure of anticholinergic drugs (Grade A). These recommendations are based on the results of international multicentric, randomized controlled trials. These studies established not only clinical benefits, with a significant decrease of urinary incontinence episodes, but also urodynamic benefits. There are very few data about the real prevalence of failure of Botox® in the long term. Thus, aims of this study were to assess the long-term outcomes of detrusor injections of Botox® associated with clean intermittent-catheterization (CIC) for the treatment of NDO and to identify risk factors for failure .
Study Type
OBSERVATIONAL
Enrollment
292
detrusor injection
Hopital Raymond Poincare
Garches, Garches, France
failure ratio
Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method.
Time frame: 3 years of follow up
Failure ratio
Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method.
Time frame: 5 years of follow up
Failure ratio
Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method.
Time frame: Seven years of follow up
withdrawal ratio
Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method.
Time frame: 3 years of follow up
withdrawal ratio
Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method.
Time frame: 5 years of follow up
Withdrawal ratio
Survival curves of withdrawals and failures of treatment were calculated with a 95-confidence interval using the Kaplan-Meier method.
Time frame: 7 years of follow up
Risk factors for failures based on and clinical, radiological and urodynamic parameters
univariate analysis and multivariate analysis using Cox model
Time frame: 3 years
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Risk factors for failures based on and clinical, radiological and urodynamic parameters
univariate analysis and multivariate analysis using Cox model
Time frame: 5 years
Risk factors for failures based on and clinical, radiological and urodynamic parameters
univariate analysis and multivariate analysis using Cox model
Time frame: 7 years