DeRidder_Cardiology_book_temp 17/03/2010 15:18 Page 42
Overactive Bladder and Incontinence
Table 1: Safety Data from Published Double-blind, Placebo-controlled, Randomised Trials with Botulinum Toxin-A in
Patients with Idiopathic Overactive Bladder
Study Increased PVR Volume (% of patients) UTI (% of patients)
BTX-A Placebo BTX-A Placebo
Sahai et al., 2007
13
38% (>150ml) with CISC for on average 14 weeks 0 21% (7 patients including 6 with CISC)
n= 34; 24 weeks
Brubaker et al., 2008
14
43% (>200ml) with CISC for median 62 days 0 44% (12 patients including 9 with CISC) 22%
n=43; 12 months
Flynn et al., 2009
16
27% (>200ml) 7% with CISC 0 13% 29%
n=22; 6 weeks
BTX-A = botulinum toxin-A; CISC = clean intermittent self-catheterisation; PVR = post-void residual; UT = urinary tract infection.
Optimisation of InterStim therapy has resulted in a fully percutaneous electric shock (6%) and pain at the lead site (5%).
26
However, many
two-stage implant procedure. In the procedure the tined lead is adverse events related to SNM do not require re-operation, but can be
placed into the third sacral nerve foramen under local anaesthesia managed by reprogramming the neurostimulator.
20
In addition, ‘tined’
and, after positive testing, the neurostimulator is inserted in the upper leads seem less prone to migration and result in a lower number of
buttock.
20
Test success rates (meaning ≥50% symptom improvement reportable events.
20
Indeed, the technical improvements in SNM over
from baseline) of approximately 80% have been reported.
20
time in combination with long-term clinical experience (allowing a
positive learning curve) have markedly lowered the incidence of
After device implantation, efficacy is generally maintained in the long adverse events and the number of revisions per implanted patient.
27
term. The longest prospective multicentre study report into refractory
urinary dysfunction (n=163) has shown a successful outcome at five Conclusion
years for 84% of patients with UUI who were successfully treated at Given that both phases of InterStim therapy are fully reversible and the
one year after implantation.
21
In accordance, 90% of the 21 patients screening test is predictive for the final outcome, one should feel
with I-OAB still had >50% improvement in at least one of the voiding encouraged to at least give SNM a try. Its front position in the second-
variables after a mean period of 16 months.
22
As a reflection of the line management of I-OAB could be enforced by the identification of
durability and good efficacy of InterStim therapy, patient quality of life optimal candidate parameters, which is a quest that continues.
28
n
was reported to be positively affected. At a mean of 27 months after
implant, 84% of patients were satisfied and 80% would choose the
Dirk De Ridder is Head of Clinic at the Department of
same treatment if they had to do all over again.
23
Urology of the University Hospital Leuven. He is also a
Board Member of the European Society for Female and
Despite variations in the literature depending on the applied
Functional Urology, Chairman of the Standardisation
Committee of the International Continence Society
procedure (with 53% of patients experiencing at least one reportable
since and an Executive Board Member of the
event overall),
24
SNM is safe with a low rate of associated morbidity.
25
International Continence Society. He was President of
Most historically reported adverse events (97%) were mild to
the European Society for Neurourology between 2004
and 2007. Dr De Ridder’s practice is split between
moderate.
24
As indicated by pooled safety data over 12 months
neurourology (including multiple sclerosis, spinal cord injury and other neurological
(n=219), these events included pain at the neurostimulator site (15%), diseases), reconstructive surgery, and urogynecology.
new pain (9%), suspected lead migration (8%), infection (6%), transient
1. Abrams P, Andersson KE, Birder L, et al., 4th International 2008;112:1311–18. 2009;55:100–20.
Consultation on Incontinence. Recommendations of the International 9. Chapple C, De Ridder D, BJU Int, 2009;104:1188–90. 19. US Food and Drug Administration. available at:
Scientific Committee: Evaluation and treatment of urinary 10. Chartier-Kastler E, Castro-Diaz D, De Ridder D, et al., www.fda.gov/NewsEvents/Newsroom/PressAnnounceme
incontinence, pelvic organ prolapse and faecal incontinence, 4th Prog Urol, 2009;19:530–37. nts/ucm149574.htm (accessed 3 December 2009).
ed, International Scientific Committee of the International 11. Schurch B, Schmid DM, Stöhrer M, N Engl J Med, 20. Spinelli M, Sievert KD, Eur Urol, 2008;54:1287–96.
Consultation on Incontinence, 2009. 2000;342:665. 21. van Kerrebroeck PEV, van Voskuilen AC, Heesakkers JPFA,
2. Irwin DE, Milsom I, Hunskaar S, et al., Eur Urol, 12. Duthie J, Wilson DI, Herbison GP, et al., Cochrane Database et al., J Urol, 2007;178:2029–34.
2006;50:1306–14. Syst Rev, 2007;3:CD005493. 22. van Voskuilen AC, Oerlemans DJAJ, Weil EHJ, et al., BJU Int,
3. Milsom I, Curr Opin Urol, 2009;19:337–41. 13. Sahai A, Khan MS, Dasgupta P, et al., J Urol, 2007;99:107–10.
4. Thüroff J, Abrams P, Andersson KE, et al., Guidelines on 2007;177:2231–6. 23. Foster RT, Sr., Anoia EJ, Webster GD, et al., Neurourol Urodyn,
Urinary Incontinence, European Association of Urology, 14. Brubaker L, Richter HE, Visco A, et al., J Urol, 2007;26:213–17.
March 2005. 2008;180:217–22. 24. Sutherland SE, Lavers A, Carlson A, et al., Neurourol Urodyn,
5. Andersson KE, Chapple CR, Cardozo L, et al., Curr Opin Urol, 15. Sahai A, Dowson C, Khan MS, et al., BJU Int, 2007;26:19–28.
2009;19:380–94. 2009;103:1509–15. 25. Nakib N, Siegel S, Nat Clin Pract Urol, 2008;5:118–19.
6. Chapple CR, Khullar V, Gabriel Z, et al., Eur Urol, 16. Flynn MK, Amundsen CL, Perevich M, et al., J Urol, 26. Siegel SW, Catanzaro F, Dijkema HE, et al., Urology,
2008;54:543–62. 2009;181:2608–15. 2000;56(Suppl. 6A):87–91.
7. Basra RK, Wagg A, Chapple C, et al., BJU Int, 17. Schmid DM, Roy S, Sulser T, et al., BJU Int, 2008;102 27. van Voskuilen AC, Oerlemans DJAJ, Weil EHJ, et al., Eur Urol,
2008;102:774–9. (Suppl. 1):7–10. 2006;49:366–72.
8. Gopal M, Haynes K, Bellamy SL, et al., Obstet Gynecol, 18. Apostolidis A, Dasgupta P, Denys P, et al., Eur Urol, 28. Burks FN, Peters KM, Curr Urol Rep, 2009;10:342–6.
42 EUROPEAN UROLOGICAL REVIEW
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