Hypothesis / aims of study
Botox injection is an established treatment for overactive bladder. The modern trend is moving towards giving this injection under Local Anaesthetic(L/A) in outpatient clinic. However, patients find difficult to tolerate the standard 20 injections technique under L/A in outpatient clinic. Therefore, to reduce the pain and discomfort of 20 injections, alternate 7 injections were tried and checked it’s safety and efficacy.
Study design, materials and methods
A prospective study involving overactive bladder patients. They were offered intra detrusor Botox injection after failed or unable to tolerate medical treatment. All procedures were performed under L/A with Flexible Cystoscope in outpatient clinic. Onabotulinum toxin A(Botox), was diluted with 10 ml of normal saline and administered as 7 intra detrusor injections- 3 in midline and 2 on either side. Symptoms were assessed with ICIQ OAB and ICIQ UI questionnaire before treatment and at follow up in 6 weeks. Complications and outcomes were also noted at follow ups. Paired ‘t’ test was done to check for statistical significance.
Results
Among total 46 patients, 63%(29) were female. 35(76%) patients had Idiopathic Detrusor Overactivity(IDO), 8(17%) had Neurogenic Detrusor Overactivity(NDO) and 3(7%) patients had sensory urgency. Average score for ICIQ OAB(Total score 16) before Botox was 11.07 ± 3.31 and after 6.76 ± 3.50 (P<0.001). Average bother score(total 40) before treatment was 31.78 ± 2.45, after 17.37 ± 5.59(P<0.001), Average for ICIQ UI(Total 21) before treatment was 12.67 ± 4.71 and after 7.22 ± 3.98(P<0.001). 82.6%(38) patients were happy with symptomatic improvement and continued further Botox treatment. 14(30%) patients were doing Intermittent Self Catheterisation(ISC). However, only 5(10.8%) patients commenced ISC after having Botox. Also 2 out of 5 did not require to continue ISC after 1 month. Therefore, 3(6.5%) patients continued ISC as long term after having Botox injections. 1(2.1%) patient had UTI but no patient was readmitted with retention or haematuria.
Interpretation of results
In this study majority of patients were female as expected. Significant symptomatic improvements were noted in all validated questionnaires. Also, overall success rate was comparable with current literatures involving standard 20 injections technique. The rate of ISC after commencing Botox treatment was low and there was no significant other complications. More than 80% patients were happy with the outcome continued subsequent treatments under L/A. Therefore this reduced number of injections treatment was non inferior to the standard.