The intravesical injection of highly purified botulinum toxin for the treatment of neurogenic detrusor overactivity.

INTRODUCTION: We aimed to assess safety and efficacy of incobotulinumtoxinA for the treatment of neurogenic detrusor overactivity (NDO). METHODS: We identified patients with NDO confirmed on urodynamics (UDS) and reported urgency incontinence (UI) in those who received intravesical incobotulinumtoxin A injection for neurogenic bladder between November 2013 and May 2017. Parameters studied were daytime frequency, daily incontinence episodes, daily pad use, clean intermittent catheterization (CIC) volumes, symptom scores (UDI6, IIQ7, PGII), and complications. RESULTS: We examined 17 male patients who met inclusion criteria and underwent incobotulinumtoxinA injection. Mean age was 61.2±15.4 years. Fourteen patients (82%) were taking oral antimuscarinics prior to the incobotulinumtoxin A injection. There were improvements in the following parameters: average daily pads (4.5 to 3.3, p=0.465), daily urinary frequency (9.4 to 4.6, p=0.048), daily incontinent episodes (2.5 to 0.4, p=0.033), CIC volumes (400 to 550 mL, p=0.356), hours in between CIC (3.6 to 5.2, p=0.127), and the validated questionnaires UDI6 (30.6 to 7.4, p=0.543) and IIQ7 (52.4 to 6.8, p=0.029). There were no documented symptomatic urinary tract infections (UTIs) within 30 days of injection or reports of de novo urinary retention. Nine of 17 patients (53%) reported being dry at their first postoperative visit. CONCLUSIONS: In this preliminary pilot study of a small cohort of males with NDO and UI, significant improvements were seen following incobotulinumtoxinA injection in daily frequency, incontinence episodes, hours in between CIC, and quality of life. Larger-scale and long-term studies are required to confirm these results, but initial findings are promising for wider use of this formulation.

Combination medical therapy for symptomatic benign prostatic hyperplasia.

PURPOSE: The purpose of this study was to evaluate treatment response to terazosin, finasteride, or a combination of both in men with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with BPH were consecutively enrolled from a clinical urology practice. International Prostate Symptom Score (IPSS), peak urinary flow rate, and prostate volume were assessed at baseline and every 2 months for 12 months. Detrusor pressure at maximum flow was assessed at baseline, 4 and 12 months. Patients were randomized into 1 of 3 treatment groups - terazosin alone, finasteride alone, or combination therapy. RESULTS: At 12 months, symptom scores had decreased significantly in all 3 treatment groups (p<0.05). Combination therapy resulted in significantly greater reductions in IPSS than terazosin or finasteride (6.4, 4.9, 4.1 points, respectively, p<0.05) There were significant increases in peak urinary flow rate within each treatment group, although there were no significant changes between groups. Detrusor pressure also significantly decreased from baseline within each treatment group. Patients treated with combination therapy had a significantly greater mean decrease in detrusor pressure after 12 months when compared with finasteride-treated patients (16.7 versus 10.5 cm H20, p<0.03). There were no significant differences between terazosin and combination therapy or between terazosin and finasteride despite the relatively greater decrease in detrusor pressure seen in the terazosin group when compared with the finasteride group. CONCLUSIONS: Combination medical therapy with finasteride and terazosin provides greater symptom relief than monotherapy in men with BPH.