Onabotulinum toxin A Injections in Men With Refractory Idiopathic Detrusor Overactivity

Abstract

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.