Loic Lenormand

Switch to Abobotulinum toxin A may be useful in the treatment of neurogenic detrusor overactivity when intradetrusor injections of Onabotulinum toxin A failed

To assess the outcomes of switching to a different brand of botulinum toxin A (BTA, from Botox® to Dysport®) in case of failure of intradetrusor injections (IDI) of Botox® in the treatment of neurogenic detrusor overactivity (NDO).

Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism

Purpose: The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida. Materials and methods: All patients with spinal dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success. Results: A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (–12 cm H2O, p <0.001), maximum cystometric capacity (86.6 ml, p <0.001) and compliance (8.9 ml/cm H2O, p = 0.002). A total of 20 complications (3.6%) were recorded for the 561 intradetrusor botulinum toxin A injections, including 3 muscular weakness complications. The global success rate of the first injection was significantly lower in patients with poor compliance (34.4% vs 86.9%, OR 0.08, p <0.001). On multivariate analysis poor compliance was associated with a lower global success rate (OR 0.13, p <0.001). Female gender (OR 3.53, p = 0.01) and patient age (OR 39.9, p <0.001) were predictors of global success. Conclusions: Intradetrusor botulinum toxin A injections were effective in adult patients with spina bifida who had detrusor overactivity. In contrast, effectiveness was much lower in adult patients with spina bifida who had poor bladder compliance. The other predictors of global success were female gender and older age.

PD64-05 SWITCH TO ABOBOTULINUM TOXIN A MAY BE USEFUL IN THE TREATMENT OF NEUROGENIC DETRUSOR OVERACTIVITY WHEN INTRADETRUSOR INJECTIONS OF ONABOTULINUM TOXIN A FAILED

patterns of core and levator ani muscles during exoskeleton-assisted over ground walking vs treadmill walking with body-weight support in motor complete SCI vs able bodied controls. METHODS: Surface EMG were recorded from the rectus abdominis, external oblique, erector spinae (ES) and levator ani bilaterally. Foot switch signals linked heel strike to EMG activity (Biometrics Ltd, Newport, UK). Baseline, quiescent EMG activity were recorded for 20 sec. during sitting and support (by exoskeleton) standing. EMG activity during exoskeleton-assisted walking were recorded over ground with the Ekso and on the treadmill with Lokomat . 40-60 steps were recorded during each walking trial, and walking speed was matched. Protocol was matched in controls. Bladder diaries and validated LUTS scores were completed. RESULTS: 3 SCI (ASIA A levels T4, T4,C7; 2 male 1 female, age 33-39 yrs, 2-25 yrs since injury) participated. EMG from PFM, abdominal and ES showed heightened activity during over ground exoskeleton-assisted walking compared to treadmill in both complete SCI and controls. Robust rhythmic bursting was observed in PFM with exoskeleton walking, but not during supported standing or sitting. Fig MVC % exoskeleton (red) vs supported treadmill (black) vs quiet rest (grey). CONCLUSIONS: EMG activity of PFM was demonstrable using over ground exoskeleton-assisted walking in motor complete SCI below the level of injury. Assisted gait training may reveal this preservation of function by imposing a higher demand on PFM compared to standing only. Potential activation of PFM with robotic gait training supports a novel direction in urologic management of SCI to challenge the levator ani; an important aspect in urinary tract function.

PD64-08 CAN WE AVOID BLADDER AUGMENTATION IN CASE OF FAILURE OF A FIRST INTRADETRUSOR BOTULINUM TOXIN INJECTIONS IN PATIENTS WITH SPINAL DYSRAPHISM?

courses per patient). The urodynamic patterns were detrusor overactivity in 48.6% of patients, isolated poor compliance in 33.6% of patients and combination of poor compliance and detrusor overactivity in 17.8%. The toxin used was in the vast majority onabotulinum toxin A at a dosage of 200 U in 43 patients (34.7%) and 300 U in 62 patients (49.2%). Twenty patients (16.1%) received initially abobotulinum toxin A 750 injections. Global success rate of the first injection was 68.8% with resolution of urinary incontinence in 73.5% of patients. Ninety-six patients (76.8%) underwent a second injection and the mean interval between the first and second injections was 7.5 months. Success rate was significantly lower in case of poor compliance (49% vs. 87%; p<0.0001). In contrast, success rates did not differ significantly between open and closed spinal dysraphism (66.7% vs. 72.3%; p1⁄40.51). The two other predictors of success were female vs. male gender (83.3% vs. 51.7%; p1⁄40.0002) and age (OR1⁄40.1; p1⁄40.005). Out of 561 injections, 20 adverse events were noted (3.6%) including three fatigue/muscular weakness. CONCLUSIONS: IDBTI seems effective in spina bifida patients showing detrusor overactivity regardless of the type of spinal dysraphism (open or closed). In contrast, the effectiveness is much lower in spina bifida patients with poor compliance bladder. The safety of IDBTI in patients with spinal dysraphism is statisfactory

PD64-07 INTRADETRUSOR INJECTIONS OF BOTULINUM TOXIN A IN ADULT PATIENTS WITH SPINAL DYSRAPHISM: RESULTS OF A MULTICENTER STUDY

METHODS: The charts of all patients who underwent a switch to IDI of ATA after failure of an IDI of OTA at six departments of neurourology were retrospectively reviewed. The main outcomes of interest were the bladder diary data and four urodynamic parameters: maximum cystometric capacity (MCC), maximum detrusor pressure (PDET max) and volume at first uninhibited detrusor contraction (UDC). Data were compared before and after treatment with OTA and ATA, using Stuart, Wilcoxon and paired-t tests for paired samples and univariate logistic regression was performed to seek for predictors of switch success. RESULTS: Out of 57 patients included, 38.6% were primary non-responders to Botox, and in secondary non-responder a median number of 5 OTA IDI were performed before failure (range 1-17). Persistent urinary incontinence was observed in 84.2% patients, and 75.4% had persistent detrusor overactivity. Six weeks after the first injection of Dysport, no adverse events were reported. A significant decrease in number of urinary incontinence episodes per day was observed in 52.63% of patients (p <0.001) and all patients experienced a reduction in PDET Max (-8.1 cmH20 on average; p1⁄40.003). MCC significantly increased by a mean of 41.2 ml (p1⁄40.02). The proportion of patients with no UDC increased significantly at after ATA injections (from 15.79% to 43.9%; p1⁄40.0002). Hence, 32 patients draw clinical and/or urodynamic benefits from the botulinum toxin switch from OTA to ATA (56.14%). After a median follow up of 21 months, 87% of responders to BTA switch were still treated successfully with BTA. In univariate analysis, three variables were associated with BTA switch success: low MCC before first ATA IDI (OR1⁄420.4;p1⁄40.01) and dose of ATA (OR1⁄4 10.9; p1⁄40.048) were predictive of increased success rates; poor compliance was predictive of lower success rate (OR1⁄40.2; p1⁄40.04). CONCLUSIONS: Most patients refractory to OTA (Botox) (56.14%) draw benefits from the switch to ATA (Dysport). Low MCC and dose of ATA were predictive of success of BTA switch while poor compliance was predictive of failure.

Can we avoid bladder augmentation in case of failure of a first intradetrusor botulinum toxin injections in patients with spinal dysraphism

Peyronnet B1, Amarenco G2, De Sèze M3, Even Schneider A4, Verrando A5, Hascoet J1, Castel-Lacanal E6, ChartierKastler E7, Denys P4, Schurch B8, Manunta A9, Gamé X6 1. Rennes University Hospital, 2. Tenon University Hospital, 3. Saint-Augustin institute, 4. Raymond Poincaré Hospital, 5. Tenon Hospital, 6. Toulouse university hospital, 7. Pitié-Salpétrière Hospital, 8. Lausanne University Hospital, 9. Rennes university hospital