Hypothesis / aims of study
Overactive bladder is a clinical entity with a high prevalence that causes a great impact on the quality of life (1). Botulinum toxin has been shown to be effective in the treatment of this pathology, improving the symptoms and life of patients (2) (3).
The objective of this study is to evaluate the outcome, complications and impact of quality of life in patients with refractory overactive bladder after intravesical application of botulinum toxin.
Study design, materials and methods
It is carried out a prospective study of 85 patients with overactive bladder refractory to medical treatment and in whom intravesical injection of 100 UI of botulinum toxin was performed between 2016 and 2018 on an outpatient basis in external consultations. The characteristics of the patients, complications and the results of the questionnaires OAB-V8 (Overactive Bladder), ICIQ-SF (Urinary incontinence) and the Health Questionnaire SF-36 (Quality of life) before and after the application of the treatment have been reviewed. The statistical analyzes were carried out with the EPIDAT software tool version 4.2. For the comparison of results, the Student’s t-test for paired data or Wilcoxon was used. A value of p < 0.05 was considered statistically significant.
Of the patients studied, 71.75% were women while 28.24% were men. The average age of the patients was 65.4 years and the average body mass index was 30.04. Approximately 20% of patients had diabetes mellitus or had a neurological history; and almost 50% also had some psychiatric or surgical / pelvic history. The most frequent complication was to present a high postvoid residual in 16.47% of the patients, followed by a positive urine culture in 9.41%. The average score of the pain scale was 3.46. No differences were observed regarding sex and complications. The changes in the parameters of the questionnaires after the month of application, compared to the pre-application assessment, were statistically significant for OAB-V8 scale and for ICIQ-SF questionnaire, but not for the Health Questionnaire SF-36. The most affected dimensions were the physical and social function and the physical and emotional role. Differences were not observed in terms of sex and age (above or below 50 years), except for the emotional role, which affected women more and at age < 50 years. Roughly 71.76% of patients reported improvement after the application of the botulinum toxin.
Interpretation of results
Overactive bladder and urinary incontinence significantly impair quality of life, with a negative impact on emotional well-being and daily activities and relationships with others. People with overactive bladder present more risk of loss of self-esteem, depression, decrease in social interaction, work absenteeism and limitation or abandonment of physical activity. We have seen that women and those under 50 years of age affected their emotional role more, probably because they have a very active social and working life. Clinical questionnaires are a simple and very useful instrument for the evaluation of symptoms and impact on quality of life; useful before and after the application of the treatment. The intravesical application of botulinum toxin is a procedure of low mortality and morbidity, which improves the symptomatology and the quality of life of these patients, making it as an adequate treatment for patients with overactive bladder in whom treatment with anicholinergic or beta-3 agonist medications have failed. It should be noted that the ICIQ-SF Questionnaire also measures the impact on life quality, and that the SF-36 Health Questionnaire can be influenced by other pathologies.