Intravesical botulinum toxin treatment for post-prostatectomy overactive bladder (OAB) appears most effective for patients with pure detrusor overactivity, according to preliminary data presented at the 2021 International Continence Society annual meeting.

Among 24 patients with post-prostatectomy incontinence who received intravesical botulinum toxin treatment, 10 had pure detrusor overactivity, 1 had pure stress urinary incontinence (SUI) with OAB symptoms, and 13 had mixed urinary incontinence (MUI).

Significant clinical improvement was found only in the group with pure detrusor overactivity, Nataniel Tan, MD, of St George’s Hospital in London, UK, reported on behalf of his team. In this group, mean total 24-hour pad use significantly declined from 2.9 pads per day before treatment to 1.6 pads per day at 3 months. Based on ICIQ-OAB (International Consultation on Incontinence Questionnaire Overactive Bladder) questionnaire responses, symptom severity scores significantly decreased 41% from 10.1 to 5.7 and bother scores decreased 26% from 26.9 to 19.9. Patient satisfaction was better among the detrusor overactivity than the MUI group (mean PG-II score 2.3 vs 3.5, respectively).

Of the 11 patients who received additional botulinum toxin treatments, 9 were from the DO group. Three patients required temporary self-catheterization after treatment. Among the 13 men with MUI, 5 received an artificial urinary sphincter or male sling.

Patients with pure detrusor overactivity reported higher satisfaction and more effective symptom control from intravesical botulinum toxin compared with patients who had MUI, Dr Tan concluded in an oral presentation. He suggested that initial treatment for men with MUI should focus on the SUI component before the DO component.

Botulinum Toxin’s Efficacy for Post-Prostatectomy OAB Varies by Subtype

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