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Successful treatment with botulinum toxin A after failed augmentation ileocystoplasty

Nature Clinical Practice Urology volume 4, pages 280–284 (2007)Cite this article

Abstract

Background A 49-year old man initially underwent clam ileocystoplasty 14 years ago. A revision of this original procedure was required 11 years ago for intractable detrusor overactivity secondary to transverse myelitis; he experienced only temporary symptomatic improvement that lasted 6 months after each procedure. Despite the use of oral anticholinergic drugs, the patient subsequently needed to perform clean intermittent self-catheterization approximately 10 times every 24 h, and when he presented to our department, he still suffered from occasional episodes of urgency incontinence that required the regular use of a penile sheath.

Investigations Symptom severity was assessed using a 4-day bladder diary.

Diagnosis Cystometry confirmed the presence of terminal detrusor overactivity.

Management After the patient provided his informed consent, he was treated as an outpatient with intradetrusor injections of botulinum toxin A, delivered under local anesthesia by a minimally invasive technique that used a flexible cystoscope. A significant improvement was noted in the patient's lower urinary tract symptoms, urodynamic parameters and quality of life, measured at 4 and 16 weeks after treatment. The patient was completely dry at both follow-up visits and was able to discontinue the use of anticholinergic drugs and the penile sheath for a total of 11 months.

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Figure 1: Changes in subtraction cystometry after treatment with BTX-A injections

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Author information

Authors and Affiliations

  1. A Apostolidis is an Urologist and Lecturer in Neuro-Urology at the Aristotle University of Thessaloniki, Greece, and a Clinical Research Fellow at the Institute of Neurology, University College, London, UK.,

    Apostolos Apostolidis

  2. R Popat is a Specialist Registrar in Urology at the National Hospital for Neurology and Neurosurgery, London, UK.,

    Roshni Popat

  3. M Harper is a Specialist Registrar in Urology at the National Hospital for Neurology and Neurosurgery, London, UK.,

    Matthew Harper

  4. CJ Fowler is a Professor of Uro-Neurology at The National Hospital for Neourology and Neurosurgery, Queen Square, London, UK.,

    Clare J Fowler

  5. P Dasgupta is a Consultant Urological Surgeon and Honorary Senior Lecturer, at Guy's Hospital, King's College London School of Medicine and The National Hospital for Neurology and Neurosurgery, London, UK.,

    Prokar Dasgupta

Authors
  1. Apostolos Apostolidis
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  2. Roshni Popat
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  3. Matthew Harper
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  4. Clare J Fowler
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  5. Prokar Dasgupta
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Corresponding author

Correspondence to Prokar Dasgupta.

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Competing interests

R Popat has declared he has no competing interests. The other authors have declared associations with the following companies/organizations: Allergan, British Urological Foundation, Multiple Sclerosis Society UK, Pfizer.

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Apostolidis, A., Popat, R., Harper, M. et al. Successful treatment with botulinum toxin A after failed augmentation ileocystoplasty. Nat Rev Urol 4, 280–284 (2007). https://doi.org/10.1038/ncpuro0799

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