B Peyronnet1, S Sanson2, G Amarenco3, E Castel-Lacanal4, E Chartier-Kastler5, K Charvier6, M Damphousse7, P Denys8, M de Seze9, G Egon10, A Even8, V Forin11, G Karsenty12, J Kerdraon13, L le Normand14, C-M Loche15, A Manunta16, P Mouracade17, V Phe5, J-G Previnaire18, A Ruffion19, C Saussine17, B Schurch20, X Game2. 1. Service d'urologie, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France. Electronic address: peyronnetbenoit@hotmail.fr. 2. Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Toulouse, France. 3. Service de neuro-urologie, hôpital Tenon, Paris, France. 4. Service de médecine physique et réadaptation, CHU Rangeuil, Toulouse, France. 5. Service d'urologie, hôpital Pitié-Salpétrière, Paris, France. 6. Service de médecine physique et réadaptation, hospices civils de Lyon, Saint-Genis-Laval, France. 7. Service de médecine physique et réadaptation, hôpital Pontchaillou, Rennes, France. 8. Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, Garches, France. 9. Cabinet de neuro-urologie, clinique Saint-Augustin, Bordeaux, France. 10. Service de médecine physique et réadaptation, Centre de L'Arche, Saint-Saturnin, France. 11. Unité pédiatrique de médecine physique et rééducation, hôpital Trousseau, Paris, France. 12. Service d'urologie, hôpital La Conception, Marseille, France. 13. Centre de rééducation de Kerpape, Ploemeur, France. 14. Service d'urologie, Hôtel-Dieu, Nantes, France. 15. Service de médecine physique et réadaptation, hôpital Mondor, Créteil, France. 16. Service d'urologie, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France. 17. Service d'urologie, nouvel hôpital civil, Strasbourg, France. 18. Département médullaire, fondation Hopale, Berck-sur-mer, France. 19. Service d'urologie, centre hospitalier Lyon Sud, Pierre-Bénite, France. 20. Service de neuroréhabilitation, CHUV, Lausanne, Suisse.
Abstract
OBJECTIVE: There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin. METHODS: A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions. RESULTS: Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%). CONCLUSION: This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.
OBJECTIVE: There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin. METHODS: A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions. RESULTS: Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%). CONCLUSION: This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.
Authors: O Blé; J Levy; C Lefèvre; M A Perrouin-Verbe; A Even; L Le Normand; E Chartier Kastler; B Perrouin-Verbe; P Denys; C Joussain Journal: World J Urol Date: 2022-06-01 Impact factor: 4.226
Authors: Jacquie Maignel; Vincent Martin; Rana Assaly; Mathieu L Vogt; Kevin Retailleau; Fraser Hornby; Alexandra Laugerotte; Stéphane Lezmi; Pierre Denys; Johannes Krupp; Charles Joussain Journal: Toxins (Basel) Date: 2022-01-21 Impact factor: 4.546