Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism

Benoit Peyronnet (1) , Alexia Even (2) , Grégoire Capon (3) , Marianne de Seze (4) , Juliette Hascoet (1) , Xavier Biardeau (5, 6) , Maximilien Baron (7) , Marie-Aimée Perrouin-Verbe (8) , Jean-Michel Boutin (9) , Christian Saussine (10) , Veronique Phe (11) , Loic Lenormand (8) , Emmanuel Chartier-Kastler (11) , Jean-Nicolas Cornu (12, 13, 14, 15) , Gilles Karsenty (16) , Andrea Manunta (1) , Brigitte Schurch (17) , Pierre Denys (18) , Gérard Amarenco (19, 20) , Xavier Gamé (21)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 Hôpital Raymond Poincaré [AP-HP]
3 service d'urologie [CHU Bordeaux]
4 Clinique Saint Augustin
5 Service d'Urologie, andrologie et transplantation rénale [CHRU Lille]
6 LilNCog - Lille Neurosciences & Cognition - U 1172
7 Service d'urologie [Rouen]
8 UN - Université de Nantes
9 Service d'urologie [Tours]
10 UNISTRA - Université de Strasbourg
11 CHU Pitié-Salpêtrière [AP-HP]
12 CHU Tenon [AP-HP]
13 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
14 IRIB - Institute for Research and Innovation in Biomedicine
15 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
16 Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM]
17 UNIL - Université de Lausanne = University of Lausanne
18 Service de médecine physique et réadaptation [CHU Raymond-Poincaré]
19 Physiologie et physiopathologie de la motricité chez l'homme
20 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
21 UT - Université de Toulouse

Purpose: The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida. Materials and methods: All patients with spinal dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success. Results: A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (–12 cm H 2O, p <0.001), maximum cystometric capacity (86.6 ml, p <0.001) and compliance (8.9 ml/cm H 2O, p = 0.002). A total of 20 complications (3.6%) were recorded for the 561 intradetrusor botulinum toxin A injections, including 3 muscular weakness complications. The global success rate of the first injection was significantly lower in patients with poor compliance (34.4% vs 86.9%, OR 0.08, p <0.001). On multivariate analysis poor compliance was associated with a lower global success rate (OR 0.13, p <0.001). Female gender (OR 3.53, p = 0.01) and patient age (OR 39.9, p <0.001) were predictors of global success. Conclusions: Intradetrusor botulinum toxin A injections were effective in adult patients with spina bifida who had detrusor overactivity. In contrast, effectiveness was much lower in adult patients with spina bifida who had poor bladder compliance. The other predictors of global success were female gender and older age.

Mots clés: spinal dysraphism; type A; urinary bladder; overactive; botulinum toxins; adult; urodynamics

Domaines: Urologie et Néphrologie

Benoit Peyronnet, Alexia Even, Grégoire Capon, Marianne de Seze, Juliette Hascoet, et al.. Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism. Journal of Urology, 2018, 200 (4), pp.875-880. ⟨10.1016/j.juro.2018.05.006⟩. ⟨hal-02418998⟩