Eficacia y seguridad de la inyección de onabotulinumtoxin A en pacientes varones con hiperactividad del detrusor tras la cirugía para incontinencia urinaria de esfuerzo / Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery

Introducción y objetivo El uso de la inyección de onabotulinumtoxin A (BoNT-A) en pacientes masculinos con hiperactividad del detrusor (HD) tras la cirugía para la incontinencia urinaria de esfuerzo (IUE) ha sido escasamente descrito. Nuestro objetivo fue evaluar los resultados de este tratamiento en esta población específica.Materiales y métodosAnálisis retrospectivo desde 2010 en pacientes varones que reciben una primera inyección de 100U de BoNT-A para el tratamiento de HD tras someterse a una cirugía previa para la IUE en nuestro departamento. La respuesta al tratamiento se valoró mediante la Escala de Beneficio del Tratamiento: 1) mejoría significativa; 2) mejoría; 3) sin cambios; 4) empeoramiento tras el tratamiento (Escala de Beneficio del Tratamiento 1 o 2: respuesta al tratamiento). Las complicaciones se catalogaron según la clasificación de Clavien-Dindo. Se consideró la continuación del tratamiento si los pacientes habían recibido una inyección de BoNT-A durante los 12 meses previos a la última revisión. Se compararon las variables urodinámicas antes y después del tratamiento.Resultados Se incluyeron 18 pacientes, con una edad mediana de 71,1 (59,1-83,5) años. Doce (66,7%) pacientes refirieron respuesta al tratamiento. Se detectaron 2 (11,1%) complicaciones: retención urinaria que requirió cateterismo intermitente limpio (Clavien-Dindo 2). No se detectaron complicaciones relacionadas con la cirugía previa para la IUE. Quince (83,3%) pacientes recibieron un seguimiento>12 meses (mediana de seguimiento 57 [15-89] meses) y todos habían suspendido el tratamiento al final del seguimiento. Se observó una mejoría significativa en la presencia de HD y en la acomodación vesical en el estudio urodinámico.ConclusiónAunque la mayoría de los hombres con HD después de la cirugía de IUE responden a la inyección intradetrusor de BoNT-A, todos interrumpen el tratamiento por motivos personales. Se trata de un procedimiento seguro, cuya

Introduction and objective The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population.Materials and methods Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared.Results Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance.Conclusion Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication (AU)

Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery.

INTRODUCTION AND OBJECTIVE: The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS: Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100 U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS: Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up >12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION: Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.

Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery. / Eficacia y seguridad de la inyección de onabotulinumtoxin A en pacientes varones con hiperactividad del detrusor tras la cirugía para incontinencia urinaria de esfuerzo.

INTRODUCTION AND OBJECTIVE: The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS: Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS: Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION: Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.

Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior / Urodynamic findings in Charcot-Marie-Tooth patients with lower urinary tract symptoms

INTRODUCCIÓN: Nuestro objetivo fue describir los síntomas del tracto urinario inferior (STUI) y los hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth (CMT) derivados a nuestro servicio de urología. MÉTODOS: Estudio retrospectivo de los pacientes con CMT diagnosticados en el servicio de neurología de nuestro centro y derivados al servicio de urología desde 2008 por sintomatología del tracto urinario inferior (STUI). Revisamos el tipo de CMT, la edad al diagnóstico, la presencia de comorbilidades que pudieran causar STUI, las características de los mismos, las exploraciones neurológicas y los hallazgos urodinámicos. RESULTADOS: Se remitieron 7 pacientes (3 varones y 4 mujeres) a nuestro servicio por STUI con una mediana de edad al inicio de los STUI de 55 (29-67) años y tiempo medio entre el diagnóstico de la neuropatía y el inicio de los STUI de 14 (1-37) años. Cinco pacientes refirieron clínica de vaciado, 3 incontinencia urinaria y 2 presentaban infecciones urinarias de repetición. Se realizaron 6 estudios urodinámicos, mostrando detrusor acontráctil neurógeno en 2 pacientes, detrusor hipocontráctil en un paciente, retraso en el tiempo de inicio de la micción en un paciente, detrusor hiperactivo en un paciente e incontinencia de esfuerzo en otro paciente. En un caso el estudio fue normal. CONCLUSIÓN: La mayoría de los pacientes con CMT y STUI refieren clínica de vaciado, pudiéndose relacionar con alteraciones urodinámicas, la mayoría en la fase de vaciado. Recomendamos la realización de estudio urodinámico en pacientes con CMT que presenten STUI y soliciten tratamiento o presenten complicaciones asociadas

INTRODUCTION: Our aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department. METHODS: Retrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings. RESULTS: Seven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 PATIENTS: Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal. CONCLUSIONS: Most of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications

Urodynamic findings in Charcot-Marie-Tooth patients with lower urinary tract symptoms. / Hallazgos urodinámicos en pacientes con enfermedad de Charcot-Marie-Tooth con síntomas del tracto urinario inferior.

INTRODUCTION: Our aim was to describe the lower urinary tract symptoms (LUTS) and urodynamic findings in Charcot-Marie-Tooth (CMT) disease patients referred to our Urology Department. METHODS: Retrospective study of those patients with CMT disease diagnosed at the Neurology Department of our Tertiary Hospital and referred to our Urology Department since 2008 due to LUTS. We reviewed their clinical charts regarding the age at CMT disease diagnosis, type of CMT disease and the presence of other comorbidities which could cause LUTS. We collected data on the characterization of LUTS, findings of neurological examination and urodynamic findings. RESULTS: Seven patients were referred to our department due to the presence of LUTS. They were 3 male and 4 female, with median age at the moment of LUTS onset of 55 (29-67) years and median time from the diagnosis of the neuropathy to the onset of LUTS was 14 (1-37) years. Voiding symptoms were referred by 5 patients and urinary incontinence by 3 patients. Two patients presented recurrent urinary tract infection. Six urodynamic tests were performed which showed a neurogenic acontractile detrusor in 2 patients, detrusor underactivity in one patient, a delayed opening time in one patient, a neurogenic detrusor overactivity in one patient and a urodynamic stress incontinence in one patient. In one patient the urodynamic test was normal. CONCLUSIONS: Most of CMT patients with LUTS complained from voiding symptoms. Several urodynamic findings could be observed mostly during the voiding phase. We recommend performing urodynamic tests in CMT patients presenting with LUTS seeking for treatment or in those with related complications.