OABSS was adjusted on all patients postoperative at 1,3,6,9 months also Urodynamic was done for all patients preoperative and postoperative at 3, 6, 9 months. The mean age was There was no statistically difference between both groups in all parameters all over the study except at 9 months after treatment.
Hematuria was observed 6 and 9 patients in group I and II respectively. Dysuria was observed in 6 and 15 patients in group I and II respectively.
There was a significant difference at month 9 towards U with more incidences of adverse events. Detrusor overactivity is defined by the presence of lower urinary tract symptoms of urgency with or without urge urinary incontinence UUI , usually with frequency and nocturia 1. In the majority of affected patients, the cause of the detrusor overactivity is idiopathic while neurogenic detrusor overactivity occurs mainly in patients with spinal cord diseases 2.
Conservative treatments lifestyle modifications, pelvic floor exercises, bladder training, and anticholinergic regimens may result in insufficient improvements and in low compliance because of bothersome adverse events 3. Botulinum toxin is a purified neurotoxin derived from clostridium botulinum and its main effect is to inhibit signal transmission at the neuromuscular junction by inhibiting the release of acetylcholine. In addition, botulinum toxin is now thought to have effects on the release of other sensory neurotransmitters such as substance P and ATP, as well as reducing the axonal expression of capsaicin and purinergic receptors 5.
Many studies demonstrated significant improvements in OAB symptoms and QoL with BoNTA treatment but they also showed increased post void residual urine, acute urinary retention and urinary tract infections 6. An informed written consent was obtained from all patients after the study protocol was approved by the Research Ethics Committee, Faculty of Medicine, Benha University. Additional use of anticholinergics was not allowed during the study period. Patients were randomly classified into two groups I and II. Urodynamic evaluation was done in the form of flowmetry and cystometry.redlemizalre.tk
Botulinum toxin in Urology - ScienceDirect
Patients were instructed to circle the score that best applied to their urinary condition during the past week; the overall score was the sum of the four scores. There were 4-symptoms evaluated: daytime frequency, nighttime frequency, urgency and urge incontinence for the questionnaire. The injection was performed in 20 sites, using degree lens and a rigid scope with a 6 Fr. The injection sites were determined after mapping of the bladder at the anterior, left lateral, right lateral, posterior walls and the trigone 0.
The injection was followed by insertion of a 16 Fr. Foley's catheter, to be removed the next morning after surgery. All patients received peri-operative I. Categorical data were presented as number and percentages while quantitative data were expressed as mean and standard deviation. The accepted level of significance in this work was stated at 0.
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Eighty patients 63 women and 17 men were enrolled in the study. The mean standard deviation ages were One patient who received U of BoNTA dropped out of the study at month 6 evaluation and another one at month 9. There were no statistically significant differences in baseline characteristics between two groups. Early postoperative hematuria was observed in 6 4 women and 2 men patients in group I and 9 6 women and 3 men patients in group II. During follow-up dysuria was observed in 6 5 women and 1 male and 15 12 women and 3 men patients in group I and II respectively.
UTI was detected in 3 2 women and 1 male and 7 5 women and 2 men patients in group I and II respectively.
Sacral neuromodulation or surgical bladder augmentation were the available options for treatment of IOAB, however they are highly invasive and have long term complications In relation to the aforementioned results, the current study showed significant improvement in all clinical symptoms frequency, nocturia, urgency and UUI after BoNTA treatment. We observed no significant difference between U and U at post injection at months 1, 3 and 6. The U BoNTA dosage demonstrated consistent improvements till the end of the study and the significant difference between the study groups was observed at month 9 after injection.
Urologic applications of botulinum toxin
The first book devoted to use of botulinum toxin BoNT in the genitourinary tract, a hot topic following FDA approval of onabotulinumtoxinA for treatment of urinary incontinence due to neurogenic detrusor overactivity Includes reviews of the latest clinical series and techniques of BoNT injection Written and edited by leading pioneers Designed to be of practical assistance to all urologists and urogynecologists wishing to use BoNT see more benefits. Buy eBook. Buy Hardcover. Buy Softcover. Rent the eBook. FAQ Policy. About this book The minimally invasive use of botulinum toxin BoNT in the lower urinary tract has revolutionized the treatment of debilitating bladder, urethra, and prostate conditions refractory to conventional therapy.
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