Presentation Authors: Ranjan Arianayagam, Lewis Chan*, Sydney, Australia, Johan Gani, Helen O'Connell, Melbourne, Australia, Vincent Tse, Sydney, Australia, Henry Yao, Melbourne, Australia
Introduction: Patients with Parkinson's Disease (PD) and extrapyramidal syndromes often report voiding dysfunction and overactive bladder symptoms (OAB). Onabotulinum Toxin A (BTXA) injections has proven efficacy in the treatment of neurogenic OAB. We report the results of intravesical BTXA injections for treatment of drug refractory OAB in PD patients from 2 academic centers.
Methods: We conducted a retrospective review of patients with drug refractory OAB who underwent BTXA at Concord Hospital from 2007 to 2018, and Western Health from 2013 to 2018. All patients had baseline multichannel video-urodynamic studies. Clinical outcomes and complications were obtained from medical records.
Results: 31 patients (mean age 73.6) had PD. 1 patient had supranuclear palsy. 11 patients had high pressure detrusor overactivity (DO) on urodynamics, 4 had decreased compliance and the remaining 17 had low amplitude DO. 10 patients had raised post void residuals (PVR) or bladder outlet obstruction, and 5 had hypocontractile bladder The remainder had a normal voiding phase._x000D_
29 patients had an initial 100 units; 3 patients (including 2 with high pressure DO), had an initial 200 units, and 9 patients had dose escalation from an initial 100 units. 17 patients had significant improvement in storage symptoms after BTXA and 8 patients reported mild improvement. 4 of 9 patients improved with dose escalation. Overall, 26 of 32 patients had an improvement in their symptoms. The majority of patients had ongoing storage symptoms despite BTXA. 5 patients regained total continence. _x000D_
Post-BTXA, 11 patients had a raised PVR, 3 of whom had a normal voiding phase. 8 patients had pre-operative bladder outlet obstruction or detrusor underactivity. 5 required temporary clean intermittent self- catheterization (ISC), 1 continued pre-operative ISC and one required an SPC. This is significantly higher than the 2% retention rate post BTXA for patients with non-neurogenic OAB at our institutions and may represent impaired voiding function in the context of progressive neurodegenerative disease.
Conclusions: Whilst the majority of patients with drug refractory neurogenic OAB bladder related to PD reported some symptom improvement following BTXA, only 53% had a good response. Approximately one third of patients had elevated residuals. Our study shows lower efficacy of BTXA therapy and a higher retention rate in PD patients and illustrates the difficulty in the management of neurogenic DO in patients with progressive neurodegenerative disease.