Discontinuation rates and inter-injection interval for repeated intravesical botulinum toxin type A injections for detrusor overactivity.

OBJECTIVE: To report discontinuation rates, inter-injection interval and complication rates after repeated intravesical botulinum toxin type A for the treatment of detrusor overactivity. METHOD: Patients with urodyamically proven detrusor overactivity who had two or more botulinum toxin type A injections in the period 2004-2011 at Freeman Hospital, Newcastle Upon Tyne, UK, were considered for the present study. Discontinuation rates, complication rates and interval between botulinum toxin type A treatments were retrospectively analyzed. RESULTS: Overall, 125 patients (median age 53 years, range 19-83 years) were included in the analysis. The female-to-male ratio was 2.4:1 and median follow up was 38 months. A total of 96 patients had idiopathic detrusor overactivity, whereas 29 had neurogenic detrusor overactivity. A total of 667 injections were carried out, with 125 patients receiving two injections, 60 receiving three injections, 28 receiving four injections, 14 receiving five injections, three receiving six injections, three receiving seven injections and two receiving eight injections. The mean interval (±standard deviation) between the first and second injection (n = 125) was 17.6 months (±10.4), between the second and third (n = 60) was 15.7 ± 7.4 months, between the third and fourth (n = 28) was 15.4 ± 8.6 months, and between the fourth and subsequent injections (n = 22) was 11.6 ± 4.5 months. A total of 26% required intermittent catheterization, and 18% developed recurrent urinary tract infections. There was a discontinuation rate of 25% at 60 months. CONCLUSION: Repeated botulinum toxin type A injections represent a safe and effective method for managing patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity. We have shown that the inter-injection interval remains unchanged up to five injections.

Oncologic Outcomes of Penile Cancer Treatment at a UK Supraregional Center.

OBJECTIVE: To report contemporary treatment outcomes of penile squamous cell carcinoma at a UK supraregional center, including patterns of therapy, oncologic results, and long-term survival. PATIENTS AND METHODS: Patients with squamous cell carcinoma treated during the period January 2000 to January 2011 were included. Records were reviewed to identify the mode of therapy (penile preserving or amputative surgery), pathology reports (reclassified according to the 2009 tumor-nodes-metastasis classification), recurrence patterns, and cancer-specific survival (CSS). Kaplan-Meier plots were used for survival analyses. RESULTS: Two hundred three patients were identified with a median follow-up of 61 months. At presentation, 165 patients (82%) were node negative, 31 (15%) were node positive, and 7 (3%) had metastatic disease. Management was penile preserving surgery (n = 99, 49%), partial penectomy (n = 49, 24%), radical penectomy (n = 48, 24%), and chemotherapy or radiotherapy for metastatic disease (n = 7, 3%). After organ-preserving surgery, the local recurrence rate was 18% (compared with 4% for amputative surgery), with 94% of recurrences occurring within 3 years. Histopathologic staging was as follows, with pTis (20%), pT1 (27%), pT2 (27%), pT3 (7%), and pT4 (1%). Kaplan-Meier analysis showed a 5-year CSS of 85% and a 10-year CSS of 81%. Five-year CSS was noted to decrease with advancing stage with pN0 tumors (92%), N1 (73%), N2 (61%), N3 (33%), and M1 (0%; P <.0001). CONCLUSION: Supraregional penile cancer management has led to considerable clinical experience in our center over the past decade. Close follow-up is vital to pick up local recurrence after penile-preserving surgery. Overall oncologic outcomes are good with a 5-year CSS of 85%.