Is botulinum toxin A an effective treatment in patients following radiotherapy?
BAUS ePoster online library. Barratt R. Jun 25, 2019; 259572; P7-8 Disclosure(s): nil
Rachel Barratt
Rachel Barratt
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Abstract
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INTRODUCTION

The response to Botox treatment in patients with idiopathic and neuropathic detrusor overactivity is well documented. However, the literature on Botox therapy in patients who have had prior pelvic radiotherapy are sparse.

Patients and methods
This is a retrospective review of all radiotherapy patients who underwent intradetrusor botulinum toxin A injection at a tertiary centre between 2007-2018.

RESULTS

35 patients were identified (26 men and 9 women). On initial video-urodynamic studies 20/35 (57%) had non-compliant bladder, with an average end fill pressure of 37 cmH2O (range 12-80cmH2O), a further 12/35 (31.4%) had early onset DO from an average of 133mls (range 49-220mls) with incontinence making compliance difficult to assess. 3 patients had end fill detrusor overactivity, with only 2 patients having normal compliance.
15 (43%) patients had good clinical response and went on to repeat injections (mean 2.35 injections, range 1-7). Of these 6/20 (30%) had poor compliance,7/12 (56%) early onset overactivity and 2/3 (66%) had end fill overactivity. Of those who had partial or poor response repeat urodynamics demonstrated persistant compliance loss and early onset overactivity. The 20 patients who did not respond to intradetrusor injections were offered cystoplasty 6/35 (17%) or urinary diversion to 2/35 (6%). Artificial urinary sphincter was offered to 2 (6%) patients due to predominance of stress leakage. Other patients were managed conservatively

Conclusions
Poor compliance is a predictor of Botox failure with only 30% showing substantive response. Early onset overactive incontinence responded in 56% and remained durable in these patients
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