(Botulinum toxin and instillations)
Intravesical treatments allow treating various functional urinary pathologies. It includes the administration of botulinum toxin, that enables the treatment of urinary incontinence associated with micturition urgency, via minimally invasive therapy. Botulinum toxin is also used in other urological disorders, such as certain bladder pain syndromes.
On the other hand, intravesical therapy is effective in the treatment of bladder pathologies associated to pain and inflammatory conditions at this level, with the intention of helping to regenerate the protective layer of the bladder mucosa, which can be affected by different infectious and inflammatory processes.
Overactive bladder syndrome: is characterised by the urgency, with or without urge urinary incontinence, usually with an increased daytime urination frequency and nocturia, and in the absence of infection or any other obvious pathology.
Overactive bladder is classified as neurogenic (NOB) when there is an identified neurological disease, being frequent causes: Parkinson’s, multiple sclerosis, spinal cord injuries or strokes, among others. NOB has an overall prevalence of 12-19%, placing an enormous burden on the healthcare system, the society, and the quality of life of the affected individuals. In urology, the use of onabotulinumtoxinA has been widely evaluated in patients with NOB.
- Pharmacological therapy
- Botulinum toxin
The conventional treatment with general measures, bladder training and first-line pharmacological treatment does not always manage to control the symptoms, in addition to abandonment due to side effects, lack of efficacy or being first-line pharmacological treatment contraindicated.
When patients are intolerant or resistant to drug treatment, the application of botulinum toxin offers high efficiency rates in patients where anticholinergics do to work or in those who could not tolerate their adverse effects.
To the improvement of clinical parameters (decrease in incontinence episodes, urgency, urination frequency, etc.), it must be added that of the urodynamic parameters (increase in maximum cystomanometric capacity, reflex volume or volume at first involuntary contraction, maximum detrusor pressure, etc.), with an average duration of the therapeutic effects of 6-12 months.
The procedure is performed under sedation and it does not require hospital admission.
The application of onabotulinumtoxinA significantly improves, not only clinical symptoms, but also urodynamic parameters in patients with OBI who have been inadequately treated with anticholinergics. This is a simple technique, with minimal adverse effects and generally well tolerated.