Onabotulinum toxin A Injections in Men With Refractory Idiopathic Detrusor Overactivity.

OBJECTIVE

To establish the effectiveness and safety profile of Onaboulinum toxin A (BTX-A) in men with idiopathic detrusor overactivity and compare with the outcomes observed in women. Several randomized trials have demonstrated the effectiveness of intradetrusor BTX-A injections in improving symptoms and quality of life in patients with overactive bladder (OAB) symptoms. Most trials however contained relatively few men or excluded men altogether.

MATERIALS AND

METHODS

Data patient undergoing BTX-A for refractory OAB with idiopathic detrusor overactivity on urodynamics were extracted from our center's prospectively maintained database. Incontinence impact questionnaire-7 and urogenital distress inventory-6 scores were collected at baseline and 4-12 weeks together with data regarding urinary retention requiring clean intermittent self-catheterization (CISC) and urinary tract infection (UTI). Urodynamic studies were assessed where available to see if voiding dysfunction and CISC were predictable.

RESULTS

Sixty-five men received 133 BoNT-A treatments in the 15-year period representing 27.8% of those with refractory OAB. Baseline urogenital distress inventory-6 and incontinence impact questionnaire-7 fell by 4.2 (P = .00) and 6.0 (P = .00) points for men and by 6.0 (P = .00) and 11.1 (P = .00) for women, respectively. De novo CISC was required in 46 (42.6%) men and 107 (35.3%) women (P = .10). UTI was reported in 36 (29.0%) men and 86 (27.0%) women (P = .73). The bladder outflow obstruction index and the bladder contractility index did not reliably predict CISC requirement.

CONCLUSION

Men with refractory OAB experience significant improvement in quality of life scores following BTX-A, though the benefit appears greater in women. The requirements for CISC and UTI rates were similar between sexes.