Treatment failure of botulinum toxin A in patients with idiopathic overactive bladder: Why do patients discontinue treatment?

Abstract

Objectives: The study aimed to evaluate the long-term compliance and reasons for discontinuation of intravesical botulinum toxin A (BoNT-A) treatment in women with idiopathic overactive bladder syndrome (iOAB). Methods: All patients who had been treated with BoNT-A between 2004 and 2010 were invited to join a written survey in June, 2015. Only women with idiopathic OAB symptoms were included. The survey was designed first to assess current urinary symptoms in patients who failed BoNT-A treatment, and second to evaluate their experiences with BoNT-A and subsequent treatments. Results: In total, 74 patients who discontinued BTX-A treatment were identified. The response rate was 62%. The most common reasons for discontinuation of treatment were insufficient effect (37%), the need for clean intermittent self-catheterization (CISC, 13%), and urinary tract infections (UTI, 9%). 17% of the patients reported that they did not want a new treatment despite good effects. After an average follow-up of 92 months, more than three quarters (76%) of the patients suffered from urgency incontinence. In most patients, incontinence had a great influence on daily life (average score of 7 on a scale of 10). During the time of this survey, 25% of the patients used drugs for their OAB symptoms, 15% were referred for sacral neuromodulation, and 1 patient underwent urinary deviation. Conclusions: Our study provides important information on the follow-up and the reasons for discontinuation in patients with idiopathic OAB. This information can be used in counselling of patients and further improvement of BoNT-A treatment.