Botulinum toxin therapy for neurogenic detrusor hyperactivity versus augmentation enterocystoplasty: impact on the quality of life of patients with SCI

Spinal Cord. 2016 Nov;54(11):1031-1035. doi: 10.1038/sc.2016.49. Epub 2016 Apr 26.

Abstract

Study design: Cross-sectional study.

Objectives: To compare quality of life (QoL) in patients with spinal cord injury (SCI) who underwent overactive detrusor treatment by botulinum toxin (BT) versus augmentation cystoplasty (AC).

Setting: France.

Methods: Prospective and descriptive study: Patients with a refractory overactive bladder due to SCI treated by at least two successive injections of BT or by AC. QoL was assessed using Qualiveen-30 (Q30). Clinical data and urodynamic parameters were collected.

Results: Thirty patients were included between March 2013 and March 2014: 14 in arm 1 (BT injections) and 16 in arm 2 (AC). Mean postoperative time after AC was 9.94 years. Mean BT injections already performed was 6.36. Qol was significantly lower in arm 1-Q30 score 1.625 versus arm 2-Q30 score 1.077 (P=0.037). Continence control was significantly higher in arm 2. Fourteen patients were completely continent (87.5%) in arm 2, whereas only 6 (42.3%) were continent in arm 1 (P=0.0187). Urinary infection, reflux, diverticula and stones were almost at a similar occurrence level.

Conclusions: QoL was found to be higher with an AC compared with BT injections. Long-time intervals between two injections and advantages specific to AC might explain in part these findings.

MeSH terms

  • Adolescent
  • Adult
  • Botulinum Toxins, Type A / therapeutic use*
  • Cross-Sectional Studies
  • Enterocytes / drug effects*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Agents / therapeutic use*
  • Quality of Life / psychology*
  • Retrospective Studies
  • Severity of Illness Index
  • Spinal Cord Injuries / complications
  • Spinal Cord Injuries / psychology*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Urinary Bladder, Neurogenic / drug therapy
  • Urinary Bladder, Neurogenic / etiology*
  • Urinary Bladder, Neurogenic / surgery
  • Urodynamics / drug effects
  • Young Adult

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A