Botulinum toxin in incontinent women with neurogenic bladder after failure with anticholinergic therapy, long-term results: a pilot study

ABSTRACT
Objective. To demonstrate the long-term efficacy and safety of intravesical botulinum toxin in the treatment of patients having neurological problems with a spontaneous voiding phase.
Patients and Methods. It is a prospective pilot study. We analysed 20 women came to the Hospital from March 2019 to March 2020 and underwent trigone-sparing Botulinum toxin bladder infiltration. The primary outcome was the improvement of the voiding diary score at two, four, twelve and twenty-four weeks and 12 months after treatment. Complications and quality of life improvement after treatment were considered as secondary outcomes.
Results. No signs of autonomic dysreflexia were observed during the procedure. Procedure associated pain has an average of 5 on Visual Analogic Scale. First benefits were evident within 2 days; full improvements were evident after 7-10 days. The duration of treatment (voiding diary score improvement) was of 5.5 months on avarage. Among the early complications: mild hematuria (no need of catheter placement) was described in 50% of patients and urinary infection in 20% of patients. None of the patients experienced fever, muscle weakness or worsened constipation. No late complications such as inability to empty bladder was described.
Conclusions. Botulinum toxin detrusor’s infiltration remains an effective and safe long term therapy in patients with neurogenic bladder with preserved voiding phase, characterized by improvement in quality of life and reduction of side effects.