Age related detrusor overactivity and symptoms perception in women: role of Botulinum toxin A injection for refractory overactive bladder

Abstract

Introduction. Detrusor overactivity has been detected in approximately 50% of women with overactive bladder symptoms. According to the NICE guidelines, urodynamic testing is mandatory confirm the diagnosis of detrusor overactivity before performing minimally invasive treatment. Material and methods. This study retrospectively analyzes 76 women, categorized into two groups based on age: reproductive age (n = 49) and climacteric period (n = 27), referred to the Timofei Moșneaga Republican Clinical Hospital between 2022 and 2024 for symptoms of overactive bladder. The research focused on physical examination, questionnaires, bladder diary, urinalysis, and urodynamic measurements before and after botulinum toxin type A injections in 30 patients with overactive bladder refractory to first-line therapy. Results. In women with overactive bladder, the reproductive group was as follows: moderate problems (51%) > very severe problems (31%), severe problems (18%) (p = 0.02); in the group of women in the climacteric period: severe problems (48%) > very severe problems (37%) > moderate problems (15%) (p = 0.10). Based on urodynamics data, the diagnosis of overactive bladder with detrusor overactivity was confirmed by establishing the presence of phasic contractions of the detrusor (3.9 ± 1.15), increased values of detrusor pressure (45.9 ± 23.9 cmH2O) and reduced bladder compliance (10.4 ± 11.4 ml/cmH2O). In 100% of cases, these findings predicted an effective botulinum toxin type A injection. Daytime urinary frequency, nocturia, and urinary urgency scores improved significantly after botulinum toxin type A injection by 41.7%, 26.1% and 34.1%, respectively. Conclusion. The study revealed age differences in overactive bladder symptom severity between the women in both groups. The reproductive period group experienced moderate complications, while the climacteric period group had more severe complications. Administration of botulinum toxin type A through detrusor injection has been shown to be efficacious in the management of overactive bladder.