Abstract:
Abstract
Introduction. The aim of study was to establish if the
treatment of overactive bladder in women and its result
reported by patients were different depending on the findings of urodynamics, performed before botulinum toxin
injection. We obtained clinical data based on the necessity and importance of performing urodynamic tests up
to surgical treatment with botulinum toxin A injection in
detrusor muscle, at patients diagnosed with idiopathic
overactive bladder and detrusor overactivity, offering a
guarantee of an effective and long-lasting treatment and
assure with predictive parameters for some postoperative
complications.
Material and methods. The research was carried out
at the Department of Urology and Surgical Nephrology,
during the years 2019 – 2022. After applying the inclusion
and exclusion criteria, 36 women diagnosed with overactive
bladder were enrolled in the prospective pilot study, aged
between 18 and 70 years, refractory to drug treatment and
investigated urodynamic by excluding/including the presence of detrusor overactivity and clinically using voiding
diary/24h, bladder symptoms and Quality of Life questionnaires before and after botulinum toxin A injection. The
primary data were analyzed and presented as a mean and
standard deviation.
Results. All women involved in the study were diagnosed clinically and urodynamic with overactive bladder, of
which 55.5% of cases were associated with detrusor overactivity and subsequently received BTX-A injectable surgical treatment with a dose of 100U. At urodynamics, the low
values of the indices obtained at cystometry were established: first sensation of bladder filling (79.8 ± 56.3 ml), first
desire to void (117.8 ± 103.2 ml), strong desire to void (162
± 125 ml) and maximal cystometric capacity (183.4 ± 139.8
ml), which correlated in 100% cases with OAB symptoms
(urinary urgency, frequency and nocturia) from the OABSS
validated questionnaire. The capacity of the bladder at each
sensation was lower, being inversely proportional to the detrusor overactivity present in women with OAB. Based on
UDS data, the diagnosis of OABi with detrusor overactivity
was confirmed by establishing the presence of phasic detrusor contractions (3.9 ± 1.1), increased values of detrusor
pressure (45.9 ± 23.9 cmH2O) and the presence of bladder
hypocompliance (10.6 ± 11.5 ml/cmH2O), these data in
100% of cases predicted an effective BTX-A injection. Daily
activity and psychosocial behavior improved after intradetrusor botulinum injections toxin was influenced by reducing daytime urination from 28% to 40% and urinary urgency from 30 to 69%.
Conclusions. This study identified a number of statistically significant urodynamic variables associated with objective clinical data, which confirm the impact of severity
of idiopathic overactive bladder symptoms and the subsequent effect of botulinum toxin type A injections in case of
urodynamic confirmation of detrusor overactivity presence.
