In this study, the use of a rigid fibre-optic endoscope prevented injection into the anterior bladder wall leading to heterogeneous distribution of the toxin within the detrusor and may thus have biased the study results. Efficacy of botulinum toxin A in the treatment of detrusor overactivity incontinence. The urodynamic data reported by Schmid et al. The treatment remained effective for five to nine months Table 2. Is the bladder a reliable witness for predicting detrusor overactivity?

However, the performance of a urodynamic status check before and after treatment can be justified when seeking to identify patients who are not likely to respond to botulinum toxin treatment or those likely to present side effects and thus require close monitoring.

Large-scale, long-term clinical and urodynamic follow-up could help better identify factors that are predictive of the success or failure of botulinum toxin treatment. In fact, in the absence of a comparative study of patients with or without detrusor overactivity, it is not possible to tell whether this latter factor is predictive of success or failure. Overactivity syndrome can lead to depression, sexual disorders, sleep disorders and absenteeism from work. Hence, it can have a clearly negative impact on quality of life.

Kalsi et al. The results were compared with cystometric and voiding diary data. This effect lasted for nine months and then declined. Grosse et al. No other authors have reported this complication with the doses used in non-neurological patients.

A risk of bladder hypocontractility and thus urine retention and the need for self-catheterization has also been reported in the literature [2,18,22,28,33,39].

Sahai et al. Furthermore, the patient inclusion and exclusion criteria in the various studies may also give rise to bias and prevent intertrial comparisons. The studies also differed in terms of the injection sites and the equipment used. Lastly, the toxin dose and dilution also varied from one study to another.

Treatment with anticholinergic agents remains the front-line treatment for NNDO. It must be attempted with a single drug or a combination, in view of the risk of intensifying the side effects.

Furthermore, new treatments and novel drugs for modulating urothelial sensitivity are under development. The intradetrusor injection of botulinum toxin A for the symptomatic treatment of NNDO has yielded encouraging preliminary results. Side effects are infrequent and primarily consist of the dose-dependent risk of urine retention. At present, this therapeutic technique should only be used in clinical research protocols.

In fact, many aspects remain to be elucidated, such as the minimal optimal dose and the risk factors for failure or the occurrence of adverse events. Le retentissement sociopsychologique parfois majeur de cette pathologie justifie une prise en charge thérapeutique adaptée. Dyskra et al. Cela évoque donc un double effet à la fois sur la partie efférente du réflexe mictionnel, mais aussi sur la régulation du message afférent.

Les injections intradétrusoriennes de la toxine botulique sont réalisées en ambulatoire ou en hospitalisation de jour. Les urines doivent être stériles. Les injections sont réalisées dans la partie superficielle du muscle détrusor.

La procédure dure généralement 20 minutes. Les injections ont été décrites initialement en intramusculaire par assimilation aux autres indications dans le muscle strié. Son effet se maintient entre six et neuf mois selon les études.

Au total, 19 études ont été réalisées. Schmid et al. La dose injectée était de U en évitant le trigone. Cinq patients se sont sentis améliorés. Les données urodynamiques ont montré à six semaines pour Schmid et al. Cependant, la réalisation du bilan urodynamique avant et après traitement peut être justifiée pour identifier les patients susceptibles de ne pas répondre au traitement par toxine botulique ou ceux pouvant présenter des effets secondaires et motivant une surveillance étroite.

Il peut avoir de ce fait un impact négatif reconnu sur la qualité de vie. Les résultats ont été comparés aux donnés du catalogue mictionnel et de la cystomanométrie.

De même, Schmid et al. Quatre-vingt-dix pour cent des patients ont rapporté une amélioration dans au moins une des catégories du king health questionnaire capacité à travailler, sommeil, participation sociale, accomplissement de taches de la vie quotidienne et effet global sur la vie de tous les jours. Join Waitlist. Apprendre Encore Plus. Faits saillants. Voucher expires February 29, Buy 1 voucher for yourself, unlimited as gifts Limit of 1 voucher per person, per visit Appointment required, call for bookings 24 hour cancellation policy or voucher is void Voucher valid for 20 units of botox only, additional units are subject to an additional charge per unit Must print and bring printed voucher for redemption Entire value must be used in a single visit by the same person All botox units are allergen Taxes and gratuities not included No cash back or credit Not valid with any offers, promotions or deal Voucher redeemable 72 hours after purchase.

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