Botox applications in resistant overactive bladder syndrome

Aim: The purpose of our study; is to assess the effect of intravesical injection of Onabotulinum toxin A on patients' quality of life and urinary symptoms in patients with treatment resistant overactive bladder syndrome. Materials and Methods: Patients who suffered from frequency, nocturia, and urgency with / without urge urinary incontinence and applied to Istanbul Faculty of Medicine Department of Obstetrics and Gynecology Division of Urogynecology between years 2014- 2018 and were diagnosed with overactive bladder syndrome after urogynecologic evaluation were taken into study. Intravesical injection of Onabotulinum toxin A was administered to all of the patients. The urogynecologic history and urogynecologic examination of all of the patients were obtained from patient files in Division of Urogynecology. Bladder diary and urodynamic parameters of patients were evaluated before and after treatment. In order to evaluate the quality of life of the patients, the pre/posttreatment outcomes of the King's Health Questionnaire, Urinary Distress Inventory-7 (UDI-7),Incontinence Impact Questionnaire ( IIQ-6),International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms ( ICIQ-FLUTS), Female Sexual Function Index (FSFI), Pelvic Organ Prolapse / Urinary Incontinence Sexual Inquiry (PISQ-12) were evaluated. During the operations, 100 Units of Onabotulinum toxin A were injected into 20 different sites. SPSS 15 (Statistical Package for Social Sciences) program was used for statistical analysis in the study. Results: A total of 20 patients were included in the study. The mean age of the patients was 56.8 ± 11.03 and the number of deliveries was 4.1 ± 2.1. 19 (95%) of the patients had at least one delivery. 18 (90%) of the patients had at least one operation history. Six of these operations were urogynecologic, eight were gynecologic (abdominal hysterectomy) and the others were not gynecologic. Ten of the patients had (50%) immediate urinary incontinence, and 10 (50%) had mixed urinary incontinence before treatment. Pelvic organ prolapse was present in 15 (75%) of the patients and the most frequent (45%) cystocele+rectocele were detected. Of the patients with POP, 14 had prolapse of 3 ° (70%) while 1 had prolapse (1 of 5). In this patient with 3 ° prolapse, Lefort Colpocleisis + Perineoplasty was performed because of anesthesia related reasons, vaginal hysterectomy could not be performed 4 Before the intravesical injection of Onabotulinum toxin, the patients received behavioral therapy, bladder training and fluid regulation. Five of the patients (25%) did not perform pelvic floor exercises. Only 1 (5%) of the patients could not use oral antimuscarinic drugs due to narrow angle glaucoma. Ten patients (50%) received combined medication before treatment. The mean pre-treatment pad test was 306 ± 605 g. In all of the patients, the procedure was performed successfully, without complications. All patients received 100 U of Onabotulinum toxin A at 20 points; trigonal injection was not performed. No patients needed urinary retention and catheterization in the postoperative period. Five of the 20 patients (25%) were injected again with intravesical Onabotulinum toxin A. Two of these 5 patients received intravesical injection of Onabotulinum toxin three times (10%) and 3 (15%) twice. In these patients, intravesical injection of Onabotulinum toxin was repeated at the earliest 10 months and at the latest 2 years. Patients spent at least 6 months without any complaints. In the evaluation of the bladder diary before and after treatment; significant decrease was observed in the diuretic fluid intake and number of leakage episodes. There was statistically significant difference in uroflowmetry parameters before and after treatment for the maximum urine flow rate. In the evaluation of the King's Health Questionnaire before and after the treatment, significant decrease was observed in total scores and all the domains except the interpersonal relations. There was no significant change in the pretreatment and posttreatment FSFI results. However, there was a significant improvement in other quality of life questionnaires including UDI-6, IIQ-7, ICIQ-FLUTS and PISQ-12, and positive change in quality of life. Conclusion: Patients did not have urinal retention or need catheterization at all after treatment. There were no complications. Five of these patients (25%) needed re-injection of intravesical Onabotulinum toxin A. Two of these 5 patients received three times and, three of these received two times intravesical Onabotulinum toxin A injection again. After treatment, we found a significant decrease in urinary incontinence of patients according to the bladder diary. Although there was a decrease in the sense of urgency, this was not found statistically significant. According to questionnaires, there was a significant improvement in quality of life. Key Words: Overactive bladder syndrome; Onabotulinum toxin A; urinary incontinence