Low doses of Botulinum A toxin in the treatment of refractory overactive bladder and
detrusor overactivity in patients with Parkinson's disease.
Silvia Giovannozzi, Silvia Proietti, Antonella Conte,* Emanuele Lepri, Luca lepri, Alfredo
Berardelli,* Antonella Giannantoni
Department of Urology and Andrology, University of Perugia, Italy
*Department of Neurological Science, “La Sapienza” University, Rome, Italy
Scopo del Lavoro
It has been previously reported that 200 Units of botulinum toxin A (BoNT/A) improves overactive
bladder symptoms and detrusor overactivity in parkinsionan patients over a three-month follow-up
period. However, some patients in that study developed post-void residual volume. Whether lower
dosages of BoNT/A yield similar results while reducing the side effects is as yet unknown.
The aim of the present study was to evaluate the effects of 100 U BoNT/A injected
intradetrusorially in patients with PD suffering from refractory overactive bladder symptoms and
detrusor overactivity.
Materiali e Metodi
Eight PD patients were enrolled in the study. At baseline evaluation, day-time and night-time
urinary frequency and episodes of urinary incontinence were recorded. Patients also completed a
standardized quality-of-life (Qol) questionnaire on incontinence (I-Qol) and a visual analogue scale
(VAS), and underwent urodynamic assessment. All the patients received a single treatment of
BoNT/A (Botox, Allergan, Irvine-CA, USA), 100 U diluted in 10 ml 0.9% NaCl injected into the
detrusor muscle at 10 sites, including the trigone, under cystoscopic control. Clinical and
urodynamic assessment, I-QoL questionnaire and VAS were repeated at one, three and six months
after treatment.
Risultati
None of the patients complained of systemic adverse events during or after the BoNT/A treatment.
During the six month follow-up, no urinary tract infections were reported, nor were any changes in
L-Dopa treatment or the clinical severity of PD recorded in any of the subjects. In all patients
BoNT/A injection induced a decrease in daytime (p=0.003), night-time urinary frequency
(p=0.006), in the number of daily episodes of urinary incontinence (p=0.008), an increase in the
Qol scores (0.002) and in VAS scores (p=0.004). Significant changes in maximum cystometric
capacity and post-void residual volume after treatment are shown in Table 1. In two patients with a
post-void residual volume of 300 ml an intermittent catheterization was performed twice daily for
one month in one and for three months in the other patient.
Discussione
In all patients 100 U of BoNT/A induced clinical and urodynamic improvements, that lasted for at
least six months. Despite of lower injected doses of BoNT/A, these PD patients presented with
post-void residual volume during follow up. Nevertheless, the need to perform IC was well
accepted in the two patients who needed of due to the concomitant disappearance of urinary
incontinence. The presence of post-void residual volume after 100 U of intradetrusorial BoNT/A in
PD patients is consistent with the results reported in patients with multiple sclerosis treated with
100 U.
Messaggio conclusivo
Intradetrusorial injection of 100 U of BoNT/A induced clinical and urodynamic improvement of
overactive bladder symptoms in patients with PD that lasted for at least six months.
Figure 1. Maximum cystometric capacity (MCC) and post-void residual volume (PVR) in
patients with Parkinson's disease at baseline, one, three and six months after BoNT/A injection.
Each bar represents mean data ±SE.