1519 RISK FACTORS OF ADVERSE EVENTS AFTER INTRAVESICAL BOTULINUM TOXIN A INJECTIONS FOR REFRACTORY OVERACTIVE BLADDER SYNDROME (2010)

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy I1 Apr 20101519 RISK FACTORS OF ADVERSE EVENTS AFTER INTRAVESICAL BOTULINUM TOXIN A INJECTIONS FOR REFRACTORY OVERACTIVE BLADDER SYNDROME Hann-Chorng Kuo, Chia-Yen Chen, and Michael Chancellor Hann-Chorng KuoHann-Chorng Kuo Hualien, Taiwan More articles by this author , Chia-Yen ChenChia-Yen Chen Hualien, Taiwan More articles by this author , and Michael ChancellorMichael Chancellor Royal Oak, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2363AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intravesical injection of botulinum toxin type A (BoNT-A) provides an alternative for non-surgical augmentation of the dysfunctional bladder. Although evidence have proven the efficacy of BoNT-A on overactive bladder (OAB), the rate of occurrence of adverse events (AE) is a concern. We evaluated our series of BoNT-A bladder injection to assess potential risk factors of AEs that may help improve patient selection. METHODS Patients who received intravesical BoNT-A injection for refractory OAB from 2004 to 2009 were reviewed. The AEs included acute urinary retention (AUR), elevated postvoid residual (PVR), straining to void, UTI, hematuria and general weakness. The incidence of AE was analyzed according to the dose of BoNT-A, site of injection, gender difference, age, co-morbidities, presence of BPH in men, and OAB subtype, baseline maximum flow rate (Qmax), PVR, voiding pressure, bladder capacity, and voiding efficiency (VE). RESULTS A total of 217 patients were studied. At 3 months, a successful result was reported in 144 (66.3%) patients and 36 (16.6%) had mild improvement. During the follow-up period, AUR occurred in 18 (8.3%), PVR¡Ù150ml developed in 103 (47.5%) and 101 (46.5%) patient reported straining to void. Gross hematuria occurred in 17 (7.8%) patients, UTI developed in 31 (14.3%) and general weakness was noted in 6 (2.8%). The success rate at 3 months showed no significant difference between all subgroups of patient demographics or urodynamic variables. Increased incidence of AUR was noted in men (odds ratio, OR=8.59), age¡U75 years old (OR=3.60), and patients with baseline PVR¡Ù100ml (OR=6.41) or VE <70% (OR=1.8). The incidence of elevated PVR and straining to void were associated with OAB-wet (OR=2.35), ageiÙ75 years (OR=1.69), baseline PVRiÙ100ml (OR=1.77) and existence of co-morbidity (OR=2.40). UTI occurred more frequently in women (OR=3.64) and men with presence of BPH (OR=7.37). 200U of Botox correlated with higher rate of elevated PVR and straining to void. No urinary retention was noted after bladder base injection. The occurrence of AUR or elevated PVR did not affect final therapeutic results. CONCLUSIONS The male gender, aging, elevated PVR, co-morbidity and higher BoNT-A dose are risk factors of potential AEs after intravesical BoNT-A injection for OAB. The clinical outcome was similarly improved despite the risk of AE. AE was minimal with 100U and bladder base injection in ourcv experience. Urologists should review patient characteristics when considering intravesical BoNT-A injections to minimize occurrence of AEs. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e586 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hann-Chorng Kuo Hualien, Taiwan More articles by this author Chia-Yen Chen Hualien, Taiwan More articles by this author Michael Chancellor Royal Oak, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...