Monitoring the loss of botulinum toxin during intradetrusor administration – pilot study results
Authors:
Vladimír Šámal 1,2; Jana Műllerová 3; Vít Paldus 1; Jan Mečl 1
Authors‘ workplace:
Urologické oddělení, Krajská nemocnice Liberec, a. s.
1; Urologická klinika Fakultní nemocnice a Lékařské fakulty UK, Hradec Králové
2; Katedra chemie, Fakulta přírodovědně humanitní a pedagogická, Technická univerzita Liberec
3
Published in:
Ces Urol 2014; 18(1): 33-39
Category:
Original article
Overview
Aim:
The aim of this study was to examine the possible loss of the onabotulinumtoxinA (onaBTA) in the course of endoscopic injection into the detrusor muscle in patients with neurogenic detrusor overactivity.
Methods:
The study group included 11 patients with neurogenic detrusor overactivity who failed standard treatment with anticholinergics. Patients were treated with endoscopic injection of 200 U onaBTA divided into 30 injection sites using a 23 G flexible endoscopic needle. In order to determine the content of onaBTA lost during endoscopic administration, methylene blue dye was added to the solution of the drug. The concentration of methylene blue was quantified using spectrofotometry in the bladder irrigant collected immediately after the final intradetrusor injection. The volume of onaBTA that was lost in the course of each procedure was subsequently calculated based the concentration of methylene blue in the solution.
Results:
In the first patient, the method for monitoring the loss of onaBTA was performed using a known loss of 13 U of onaBTA. In the following 10 patients there was a loss of 2.6 ± 1.67 U onaBTA during endoscopic administration onaBTA to detrusor.
Conclusions:
In this pilot study, we demonstrated that compared to the total injected volume, the loss onaBTA during endoscopic injection in the detrusor was negligible.
Key words:
botulinum neurotoxin, onabotulinumtoxinA, neurogenic detrusor overactivity, endoscopic administration, detrusor injection.
Sources
1. Apostolidis A, Dasgupta P, Fowler CJ. Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol 2006; 49(4): 644–650.
2. Apostolidis A, Popat R, Yiangou Y, et al. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol 2005; 174(3): 977–982; discussion 982–983.
3. Chancellor MB, Fowler CJ, Apostolidis A, et al. Drug Insight: biological effects of botulinum toxin A in the lower urinary tract. Nat Clin Pract Urol 2008; 5(6): 319–328.
4. Dressler D, Benecke R. Pharmacology of therapeutic botulinum toxin preparations. Disabil Rehabil 2007; 29(23): 1761–1768.
5. Dressler, D. Botulinum toxin mechanisms of action. Suppl Clin Neurophysiol 2004; 57: 159–166.
6. Mehnert U, Boy S, Schmid M, et al. A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging. World J Urol 2009; 27(3): 397–403.
7. Schurch B, Stohrer M, Kramer G, et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164(3): 692–697.
8. Schurch B, De Seze M, Denys P, et al. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol 2005; 174(1): 196–200.
9. Cruz F, Herschorn S, Aliotta P, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol 2011; 60(4): 742–750.
10. Ginsberg D, Gousse A, Keppenne V, et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol 2012; 187(6): 2131–2139.
11. Kuo HC. Therapeutic effects of suburothelial injection of botulinum a toxin for neurogenic detrusor overactivity due to chronic cerebrovascular accident and spinal cord lesions. Urology 2006; 67(2): 232–236.
12. Krhut J, Samal V, Nemec D, Zvara P. Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study. Spinal Cord 2012; 50(12): 904–907.
13. Mangera A, Andersson KE, Apostolidis A, et al. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol 2011; 60(4): 784–795.
14. Klein AW. Dilution and storage of botulinum toxin. Dermatol Surg 1998; 24(11): 1179–1180.
15. Coelho A, Cruz F, Cruz CD, Avelino A. Spread of onabotulinumtoxinA after bladder injection. Experimental study using the distribution of cleaved SNAP-25 as the marker of the toxin action. Eur Urol 2012; 61(6): 1178–1184.
16. Krhut J, Zvara P. Intravesical instillation of botulinum toxin A: an in vivo murine study and pilot clinical trial. Int Urol Nephrol 2011; 43(2): 337–343.
17. Grosse J, Kramer G, Stohrer M. Success of repeat detrusor injections of botulinum a toxin in patients with severe neurogenic detrusor overactivity and incontinence. Eur Urol 2005; 47(5): 653–659.
18. Kuo HC. Urodynamic evidence of effectiveness of botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents. Urology 2004; 63(5): 868–872.
19. Rapp DE, Lucioni A, Katz EE, et al. Use of botulinum-A toxin for the treatment of refractory overactive bladder symptoms: an initial experience. Urology 2004; 63(6): 1071–1075.
20. Del Popolo G, Filocamo MT, Li Marzi V, et al. Neurogenic detrusor overactivity treated with english botulinum toxin a: 8-year experience of one single centre. Eur Urol 2008; 53(5): 1013–1019.
21. Karsenty, G, Boy, S, Reitz A. Botulinum toxin A (BTA) in the treatment of neurogenic detrusor overactivity incontinence (NDOI): a prospective randomized study to compare 30 vs. 10 injections sites [abstract 93]. Neurourol Urodyn 2005; 24: 547–548.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2014 Issue 1
Most read in this issue
- Leydig cell tumor
- Benign retroperitoneal schwannoma
- Leydig cell tumor of the testis
- Squamous cell carcinoma of the renal pelvis