F. Santaniello

Botulinum A toxin in the treatment of neurogenic detrusor overactivity: a consolidated field of application.

Several studies show promising results in terms of both clinical and urodynamic improvements, supporting the efficacy, safety and tolerability of botulinum toxin serotype A (BoNT‐A) for managing neurogenic detrusor overactivity (DO). DO due to spinal cord injuries represents the most frequently treated dysfunction, where the efficacy appears to be high, with beneficial effects on quality of life. Data on the management of DO in patients with multiple sclerosis, cerebrovascular accidents and Parkinson’s disease are scarce or absent; thus, the suitability of BoNT‐A in the treatment neurogenic DO of other diseases of central nervous origin requires further investigation. Indeed, good quality, randomized controlled trials are still needed to identify not only the most appropriate patients to treat, but also the appropriate dose, administration technique, frequency of treatment and any eventual long‐term complications. Thus, the use of intravesical BoNT‐A in the control of neurogenic DO appears to be promising, but the drug is still in phase 3 clinical development, and further high‐quality research is essential.

MP09-04 COMPARISON BETWEEN TADALAFIL 5 MG VS. SERENOA REPENS/SELENIUM/LYCOPENE FOR THE TREATMENT OF BENIGN PROSTATIC LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA. A PHASE IV, RANDOMIZED, MULTICENTER, NON-INFERIORITY CLINICAL STUDY. SPRITE STUDY.

Tadalafil is one of the PDE5 inhibitors, and was reported to have prominent beneficial effects on subjects in some studies. However, to the best of our knowledge, the objective effects of this drug on storage and voiding function based on a urodynamic study (UDS) have not yet been reported. In this study, we investigated the effects of tadalafil on storage function and bladder outlet obstruction (BOO) based on a UDS in patients with LUTS due to BPE. METHODS: This open-label, single-center prospective study recruited 65 outpatients with untreated BPE. The patients received tadalafil 5 mg a day for 12 weeks. Before and 12 weeks after drug administration, International Prostate Symptom Score (IPSS), IPSSquality of life (QOL), and Overactive Bladder Symptom Score (OABSS) were used for assessing subjective symptoms. To evaluate storage function, first desire to void (FDV), maximum cystometric capacity (MCC), and the incidence of detrusor overactivity (DO) were measured, while the maximum flow rate (Qmax), detrusor pressure at Qmax (PdetQmax), post-void residual urine (PVR), and BOO index (BOOI) were assessed as parameters of voiding function. RESULTS: A total of 60 patients with a mean age of 70.1 years and mean prostate volume of 46.7 mL were included in the analysis. Subjective symptom parameters such as IPSS, IPSS-QOL, and OABSS improved significantly at 12 weeks after treatment. In the storage phase of UDS, FDV and MCC significantly increased. Besides, out of 33 patients with DO before administration of tadalafil, 14 (42.4%) patients showed apparent improvement in DO after administration. In the voiding phase, the mean Qmax significantly increased from 7.1 to 9.0 mL/s. The mean BOOI significantly decreased from 61.6 to 47.7. CONCLUSIONS: Tadalafil was effective for relieving LUTS by improving storage and voiding function as well as subjective symptoms in patients with BPE.

BOTULINUM A TOXIN INTRAVESICAL INJECTIONS IN THE TREATMENT OF PAINFUL BLADDER SYNDROME: A PILOT STUDY

OBJECTIVE We evaluated the efficacy and tolerability of botulinum A toxin (BTX-A) intravesical injections in patients affected by painful bladder syndrome with increased urinary frequency, refractory to conventional treatment modalities. METHODS Twelve women and two men were prospectively included in the study. Under short general anaesthesia patients were given injections of 200 U of commercially available BTX-A diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the trigone and bladder floor under cystoscopic control. Voiding chart, the Visual Analog Scale (VAS) for pain, and urodynamics were performed before treatment and 1 and 3 mo afterward. RESULTS Overall, 12 patients (85.7%) reported subjective improvement at 1 and 3 mo follow-up. The mean VAS score was significantly reduced at 1 and 3 mo after treatment (p<0.05 for both); at the same time points daytime and nighttime urinary frequency significantly decreased (p<0.01 and p<0.05, respectively), and bladder cystometric capacity significantly increased (p<0.01). Two patients reported incomplete bladder emptying. We did not detect any systemic side effects during or after treatment. CONCLUSIONS The results of this pilot study indicate that BTX-A intravesical injections are effective in the short-term management of painful bladder syndrome. By modulating afferent C-fiber activity within the bladder walls, BTX-A significantly improves urodynamic parameters and reduces bladder pain and urinary frequency.