Evaluation of urodynamic changes, after the use of botulinum-a toxin injections into the detrusor, in patients with HTLV1 related detrusor over activity who are resistant to anticholinergic therapy

Document Type : Research Paper

Authors

1 Associated professor Of Urology / Mashhad University Of Medical Sciences, Mashhad, IRAN

2 Urology assistant / Mashhad University Of Medical Sciences, Mashhad, IRAN

3 Professor Of Urology, / Mashhad University Of Medical Sciences, Mashhad, IRAN

4 Fellowship of endourology / Mashhad University Of Medical Sciences, Mashhad, IRAN

Abstract

Introduction:Human T Lymphocytic Virus-type 1, in 3% of carriers causes HTLV-1 Associated Myelopathy /Tropical Spastic Paraparesis. Detrusor overactivity is the most common urodynamic finding. In this study the use of botulinum-A toxin injections into the detrusor, as an alternative approach in patients with HTLV1 related detrusor overactivity who are resistant to anticholinergic therapy or with side effects of the medication, was introduced.
Materials and Methods: A total of 25 patients with HTLV1 infection and suffering from severe signs of overactive bladder who were resistant to conservative and medical treatment, had been included in this study. Urodynamic study were done, then 300 IU of botulinum toxin type A was injected into the detrusor. The  reassessment and follow up were performed with urodynamic study  3 months later.
Results: Overall 20 patients ( 80%) had high Maximum Detrusor pressure, higher than normal and after the injection reduced to 4 patients ( 16%) (p< 0.001). From them, 2 patients had urinary  leakage during cystometry,19 patients (76%) had Uninhibited bladder contractions and after the intervention decreased to 5 patients (20%) (p< 0.001) and  from them, 2 patients had urinary  leakage during cystometry.
Conclusion: Injection of botulinum neurotoxin type A showed to be effective in patients with HTLV-1 related  bladder overactivity, according to the improvement of urodynamic study parametres. This treatment can have a major impact on future management of patients with resistance to anticholinergic therapy or with side effects of this medication.

Keywords

medical journal of mashhad university of medical sciences
Volume 57, Issue 2 - Serial Number 2
May and June 2014
Pages 473-479

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