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Increased Risk of Large Postvoid Residual Urine and Lower Long-Term Success Rate in Frail Elderly after Intravesical Onabotulinumtoxin A Injection for Refractory Idiopathic Detrusor Overactivity.
MedLine Citation:
PMID:  23178902     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Intravesical injection of onabotulinumtoxin A (BoNT-A) is effective for idiopathic detrusor overactivity (IDO) refractory to antimuscarinics. However, safety is a major concern, especially for the elderly. We investigate the efficacy and safety of intravesical BoNT-A injections for refractory IDO in frail elderly. MATERIALS AND METHODS: From 2004-2009, 166 patients with urodynamic IDO refractory to previous antimuscarinics for more than 3 months received one intravesical 100U BoNT-A injection. "Frail elderly" was defined as those elder than 65 years with the presence of 3 or more of the following criteria: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed, and low physical activity. Treatment results were assessed using patients' perception of bladder condition (PPBC), voiding diary, urodynamic parameters, and Kaplan-Meier estimates of survival plots. RESULTS: Subjects were 61 frail elderly, 63 elderly without frailty, and 42 younger than 65 years. Large post-void residual (PVR) volume (>150 mL) after BoNT-A injection was significantly higher in the frail elderly group (60.7%) than in the other groups (39.7% and 35.7%, p=0.018). Urinary retention developed in 7(11.5%) frail elderly, 4(6.3%) elderly without frailty, and 1(2.4%) younger subjects (p=0.203); the duration of recovery was significantly longer in the frail elderly. The cumulative success rate was significantly lower in the frail elderly than in the other 2 groups (p=0.009). CONCLUSIONS: Although safety and efficacy were similar between elderly without frailty and younger patients, an increased risk of large PVR and lower long-term success rate in frail elderly were noted after intravesical BoNT-A injection for refractory IDO.
Authors:
Chun-Hou Liao; Hann-Chorng Kuo
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-20
Journal Detail:
Title:  The Journal of urology     Volume:  -     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, Hualien, Taiwan.
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