Study design, materials and methods
We conducted a study from a retrospective surgical database of patients who received intravesical Botox for rIDO. Urodynamic studies were performed in all patients prior to Botox injections. From our procedure database, records were assessed for 107 patients between January 2017 and October 2018. A total of 25 patients with rIDO received 100U of Botox during this period. Data were collected for demographics, injection technique and complications. Patients were contacted and asked to complete questionnaires to include Patients’ global impression scores. Details of pre-operative symptom severity and post-operative symptom improvement and QoL were gathered retrospectively using the Patient Global Impression scales including PGI-S, PGI-I and PGI-QoL. PGI-S is a severity scale which includes responses ‘mild’, ‘moderate’ or ‘severe’. PGI-I evaluates Patient Global impression of improvement of symptoms on a scale of 1 to 7 (‘very much better’ to ‘very much worse’). PGI-QoL is a quality of life assessment scale (scores 0 to 6; Delighted to terrible). In addition, we asked the patients whether they would like further repeat injections when symptoms recur.
Out of the 25 patients who received 100U of Botox, complete dataset was available for 21 patients. The technique used involved intradetrusor trigone sparing injections in all patients. Mean age was 74 years (range 51 to 91 years). Male: Female ratio was 1: 2 (male: n = 14; female: n = 7). Prior to the procedure, 16 (76%) out of 21 patients reported severe symptoms, whereas the remainder (5 patients) reported ‘moderate’ symptoms on the PGI-S scale. None of the patients reported ‘mild’ symptoms prior to Botox. After the procedure, 4 (19%) reported UTI requiring antibiotics early post-operatively, 2 (10%) had transient urinary retention, whereas only 1 patient had to perform long term ISC. On the PGI-I scale, 17 (81%) patients felt symptom improvement, while 4 (1.9%) patients reported worsening of symptoms. Amongst those who reported symptom improvement, the responses were 'much better' or 'very much better' for 11 (52%) patients. Overall 16 (76%) patients were either 'delighted' (n=4), 'pleased' (n = 4) or 'satisfied' (n = 8) on the PGI-QoL scale. However, a total of 5 patients had a ‘mixed’, ‘unhappy’ or ‘terrible’ response on the quality of life scale. Out of the entire group, 15 (72%) patients wanted to have repeat treatments.
Interpretation of results
In our study, complication rate amongst patients who received 100U of Botox was acceptable, with a very low catheterisation rate after injections. A high number of patients had ‘severe’ symptoms prior to Botox injections. Three quarters of patients experienced improved symptoms and QoL with 100 Units of Botox. The majority of patients requested repeat treatments due to high satisfaction with the injections.