Technical aspects of botulinum toxin type A injection in the bladder to treat urinary incontinence: Reviewing the procedure

• Type: Another Publication in an International Scientific Journal
• Date: 2014

Authors

Karsenty, G (Author) Other; Baverstock, R (Author) Other; Carlson, K (Author) Other; Diaz, DC (Author) Other; Francisco Cruz (Author) FMUP; Dmochowski, R (Author) Other; Fulford, S (Author) Other; Giannantoni, A (Author) Other; Heesakkers, J (Author) Other; Kaufmann, A (Author) Other; Peyrat, L (Author) Other; Thavaseelan, J (Author) Other; Dasgupta, P (Author) Other

Journal

Title: International Journal of Clinical Practice

Vol. 68

Pages: 731-742

ISSN: 1368-5031

Publisher: Wiley-Blackwell

Indexing

Scopus - 26 Citations

Other information

Authenticus ID: P-009-DRW

DOI: 10.1111/ijcp.12360

Abstract (EN): Aims Standardise the injection technique with botulinum toxin type A (BoNT A) in the bladder of patients with overactive bladder (OAB) [idiopathic overactive bladder (iOAB) or neurogenic overactive bladder (nOAB) with urinary incontinence], using a literature review and a survey of an International expert panel. Methods PubMed literature searches of BoNT A in adults with iOAB/nOAB together with a survey of 13 experts from 10 countries. Results Data from 21 articles and completed questionnaires were collated. The procedure can be carried out in an out-/inpatient setting. Dose used in clinical studies vs. clinical practice was 300 and 200 U for nOAB and 200 and 100 U for iOAB. Recent studies have also demonstrated that there are no clinically relevant benefits between 100 and 150 U in iOAB or between 300 and 200 U in nOAB, though adverse effects are increased with higher doses. Usually, 30 sites for nOAB (range: 6.7-10 U/ml) and 20-30 sites for iOAB (range: 5-10 U/ml) are injected in clinical studies vs. 20-30 sites of 1 ml/injection for 200 U in nOAB and 10-20 sites of 0.5-1 ml/injection for 100 U in iOAB in clinical practice. BoNT A is usually injected directly into the detrusor, sparing the trigone. Flexible or rigid cystoscopes are used. The needle should be typically 22-27 gauge and 4 mm in length and should have a stopper to avoid any leakage or perforation of the bladder wall while ensuring a targeted injection. Conclusion Based on the literature and survey analysis, recommendations are proposed for the standardisation of the injection procedure. © 2014 John Wiley & Sons Ltd.

Language: English

Type (Professor's evaluation): Scientific