Objective

Intradetrusorial injection of botulinum toxin A (IDBT) is a validated treatment for neurogenic and non-neurogenic refractory overactive bladder. In the elderly, muscarinic antagonists have many side effects, in particular in cognition. An alternative treatment is, for that reason, interesting in this frail population with multiple medication use. The question of efficacy is remaining. Indeed, bladder dysfunction is most of the time a multifactorial issue in the elderly. The objective of this study was to evaluate prospectively the efficacy and safety of IDBT in this population.

Materials/patients and methods

All patients aged more than 65 years who received a first IDBT were included. The clinical effects, anti-muscarinic drug intake, urodynamic parameters and adverse events were assessed before and 3 months after IDBT. The number of IDBT, the dose injected and their efficacy were also recorded.

Results

From April 2002 to February 2016, 54 elderly patients (23 male and 31 female) were enrolled, mean age of 71 years + –4.7. Forty-four patients (81%) had a neurological disease. The doses injected were: 50UBotox ( n = 2), 100U ( n = 5), 150U ( n = 2), 200U ( n = 24), 300U ( n = 21). Two patients were lost to follow-up, three had not been evaluated yet. 50% of patients had a complete subjective improvement, incomplete for 27%. After repeated IBTD, 64.5% had a complete improvement, incomplete for 8.3%. Incontinent patients decreased from 88% to 47.8% ( p < 105). Anti-muscarinic drug intake decreased from 79.0% patients to 23.3% ( p = 0.008). After repeated IDBT, 53.6% patients had complete clinical efficacy for the dose of 300UBotox, 39.3% for 200UBotox and 7.1% for 100U Botox. 36.3% patients had complete urodynamic efficacy after the first IDBT, and 65.2% after repeated IDBT. One severe side effect had been reported (hematuria). Over the 16 patients with spontaneous micturition, 9 had to start intermittent catheterizing after IDBT, but 4 had previous post-void residual volume >100 mL.

Discussion/Conclusion

IDBT is a safe and efficient treatment for refractory overactive bladder that can be proposed in the elderly, as an alternative to muscarinic antagonists in order to reduce side effects in this frail population. Clean intermittent catheterizing can be necessary, but is not a contraindication even in this population.