[29] Time of onset of symptom relief after intraoperative detrusor injection of botulinum toxin A in patients with neurogenic and non-neurogenic overactive bladder syndrome

Objective To investigate the controversy that still exists regarding the time of onset of symptom relief after intraoperative detrusor injection of botulinum toxin A (BOTOX) in patients with neurogenic and non-neurogenic overactive bladder syndrome (OAB), as intra-detrusor injection of botulinum toxin has emerged as a second-line option for patients with neurogenic and non-neurogenic OAB who are refractory to first-line treatment modalities. Methods This is a retrospective study of 71 patients, who underwent intra-detrusor injection of botulinum toxin A from December 2012 to December 2017. All procedures were performed in a single institute by the same surgeon. Data analysed included patient demographics, disease specifics, and outcomes of the procedure. Results The mean (range) age of the 71 patients was 44 (14–75) years, 48 of which were females (68%). In all, 58% of the patients had neurogenic bladder and 42% had non-neurogenic bladder. Metabolic syndrome was identified in 36 patients (50%) and 24 (34%) had neurological deficits. The neurogenic bladder group received 200 U of BOTOX, whereas the rest received 100 U. The median response time to BOTOX injection was 7 days and this was used as a threshold: Group 1 was early response ( ⩽ 7 days) and Group 2 late response ( u003e 7 days). This was utilised to analyse the effect of certain variables on response time. Age, gender, smoking status and underlying pathology had no significant effect on response time with P values of 0.14, 0.95, 0.71 and 0.7, respectively. Only diabetes and type of incontinence (wet vs dry) played a significant role with regards to response time with P values of 0.004 and 0.009, respectively. Conclusion The median time of onset after intradetrusor BOTOX injection was found to be 7 days. Only diabetes and type of incontinence significantly affected the response time to BOTOX injection. A larger sample size and a prospective analysis of data are warranted to verify and validate these findings.