What is the effect on quality of life of botulinum toxin injections to treat neurogenic detrusor overactivity?

Updated: Mar 06, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Khan et al, in a prospective, open-label, single-center study evaluating the effect of repeat detrusor botulinum toxin A injections on urinary symptoms, health, and QoL in 137 patients with refractory NDO secondary to multiple sclerosis who were treated with botulinum toxin A between 2002 and 2009, found that these repeat injections resulted in sustained improvements in QoL. [8]

Of the patients in this study who underwent detrusor botulinum toxin A treatment, 99 (72%) returned for a second treatment; 47, 25, 14, and 5 returned for retreatments 3, 4, 5, and 6, respectively. [8] Impact on QoL was assessed by means of the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), and the EuroQol-5 Dimensions questionnaires before and 4 weeks after botulinum treatment.

The mean UDI-6 and IIQ-7 scores showed considerable improvement 4 weeks after each treatment, even when repeated 6 times. [8] The mean differences in UDI-6 and IIQ-7 scores were 38.2 and 46.2, respectively, for injection 1, 33.5, and 40.1 for injection 2, 38.6 and 41 for injection 3, and 33.7 and 41.6 for injection 4. Before the first injection, 65% relied on CIC; after the first treatment, 95% relied on CIC.

Kalsi et al used the short forms of UDI-6 and IIQ-7 to evaluated changes in QoL 4 and 16 weeks after treatment with intradetrusor botulinum toxin A injections (300 U for NDO and 200 U for IDO) in 48 patients (32 with NDO and 16 with IDO); they found highly significant improvements in QoL at 4 weeks, which were maintained at 16 weeks in both patient subgroups. [9]


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