Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Practice Patterns of Turkish Urologists Regarding Intravesical Botulinum Toxin-A Injections for Overactive Bladder and Neurogenic Lower Urinary Tract Dysfunction: A Survey Study
Türk Ürologlarının Aşırı Aktif Mesane ve Nörojenik Alt Üriner Sistem Disfonksiyonu İçin İntravezikal Botulinum Toksin-A Enjeksiyonlarına İlişkin Uygulama Yöntemleri: Anket Çalışması
Burhan COŞKUNa , Ömer BAYRAKb , Seniha ÇORABAYc , Ahmet TAHRAd , Ahmet KARAKEÇİe , Yunus ÇOLAKOĞLUf, Yavuz Onur DANACIOĞLUg, Kadir ÖNEMh
aDepartment of Urology, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
bDepartment of Urology, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
cDepartment of Bioistatistics, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
dDepartment of Urology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Türkiye
eDepartment of Urology, Fırat University Faculty of Medicine, Elazığ, Türkiye
fDepartment of Urology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
gDepartment of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
hDepartment of Urology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
J Reconstr Urol. 2023;13(2):67-75
doi: 10.5336/urology.2023-98660
Article Language: EN
Full Text
ABSTRACT
 Objective: We aimed to understand the practices of Turkish urologists using intravesical onabotulinum toxin-A (BoNT-A) injections for refractory overactive bladder (OAB) and neurogenic lower urinary tract dysfunction (NLUTD) treatment, focusing on pre, peri, and postoperative management. We also explored the potential influence of functional urology workload on these practices. Material and Methods: A cross-sectional survey was circulated via the Turkish Association of Urology's WhatsApp group, collecting data on practices and preferences related to BoNT-A treatment. Statistical analysis was performed for comparisons between categorical groups. Results: 65 urologists participated. Most targeted population was NLUTD patients (40%). Preoperatively, spinal or general anesthesia was the preferred method (55.4%). For perioperative prophylaxis, second-generation antibiotics were popular (43.1%). BoNT-A dosage typically was 100 units for first OAB application (92.3%), while 200 units for first NLUTD application (70.8%). The injection site was usually the detrusor (44.6%), with most refraining from trigone injections (63.1%). Respondents with the functional urology workload >25%, favored 300 units for the first NLUTD application (p=0.009), trigone injections (p<0.001), and a second application between 3-5 months (p=0.016). Conclusion: Significant variations have been identified in the usage of BoNT-A for the treatment of OAB and NLUTD by Turkish urologists, largely influenced by the functional urology workload. Understanding these differences will help refine treatment strategies and highlight the need for more research and more specific guidelines.

Keywords: Urinary bladder, overactive; urinary bladder, neurogenic; botulinum toxins, Type A; cross-sectional studies
ÖZET
 Amaç: Bu çalışmada, Türk ürologlarının dirençli aşırı aktif mesane (AAM) ve nörojenik alt üriner sistem disfonksiyonu (NAÜSD) tedavisinde intravezikal onabotulinum toksin-A (BoNT-A) enjeksiyonlarında pre, peri ve postoperatif yönetimindeki yönelimlerinin tespit edilmesi amaçlandı. Ayrıca, fonksiyonel üroloji iş yükünün bu uygulamalar üzerindeki potansiyel etkisi de araştırıldı. Gereç ve Yöntemler: Türk Üroloji Derneğinin WhatsApp grubu aracılığıyla, BoNT-A tedavisi ile ilgili uygulamalar ve tercihler hakkında veri toplayan kesitsel bir anket uygulandı. Kategorik gruplar arasındaki karşılaştırmalar için istatistiksel analiz yapıldı. Bulgular: Çalışmaya 65 ürolog katıldı. En çok hedeflenen popülasyon NAÜSD hastalarıydı (%40). Preoperatif olarak spinal veya genel anestezi tercih edilen yöntemdi (%55,4). Perioperatif profilaksi için en fazla tercih edilen ikinci kuşak antibiyotiklerdi (%43,1). BoNT-A dozajı tipik olarak ilk AAM uygulaması için 100 ünite (%92,3), ilk NAÜSD uygulaması için 200 ünite (%70,8) idi. Enjeksiyon bölgesi genellikle detrusordu (%44,6) ve katılımcıların çoğu trigon enjeksiyonundan (%63,1) kaçınıyordu. İş yükü >%25 olan katılımcılar, ilk NAÜSD uygulaması (p=0,009), trigon enjeksiyonları için (p<0,001) ve 3-5 ay arasında ikinci bir uygulama (p=0,016) için 300 üniteyi tercih ettiler. Sonuç: Türk ürologlar tarafından AAM ve NAÜSD tedavisi için BoNT-A kullanımında, büyük ölçüde fonksiyonel üroloji iş yükünden etkilenen, önemli farklılıklar belirlenmiştir. Bu farklılıkları anlamak, tedavi stratejilerini iyileştirecek ve daha fazla araştırmaya ve daha kesin kılavuzlara olan ihtiyacı vurgulayacaktır.

Anahtar Kelimeler: Mesane, aşırı aktif; mesane, nörojenik; botulinum toksinler, A tipi; kesitsel çalışmalar
REFERENCES:
  1. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al; Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49. [Crossref]  [PubMed] 
  2. Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008;9(6):453-66. [Crossref]  [PubMed]  [PMC] 
  3. Brubaker L, Richter HE, Visco A, Mahajan S, Nygaard I, Braun TM, et al; Pelvic Floor Disorders Network. Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol. 2008;180(1):217-22. [Crossref]  [PubMed]  [PMC] 
  4. Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol. 2000;164(3 Pt 1):692-7. [Crossref]  [PubMed] 
  5. Kelleher C, Hakimi Z, Zur R, Siddiqui E, Maman K, Aballéa S, et al. Efficacy and tolerability of mirabegron compared with antimuscarinic monotherapy or combination therapies for overactive bladder: a systematic review and network meta-analysis. Eur Urol. 2018;74(3):324-33. [Crossref]  [PubMed] 
  6. Nitti VW, Ginsberg D, Sievert KD, Sussman D, Radomski S, Sand P, et al; 191622-096 Investigators. Durable efficacy and safety of long-term onabotulinumtoxinA treatment in patients with overactive bladder syndrome: final results of a 3.5-year study. J Urol. 2016;196(3):791-800. [Crossref]  [PubMed] 
  7. Kuo HC, Chancellor MB. Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. BJU Int. 2009;104(5):657-61. [Crossref]  [PubMed] 
  8. Giannantoni A, Mearini E, Di Stasi SM, Mearini L, Bini V, Pizzirusso G, et al. Assessment of bladder and urethral sphincter function before and after radical retropubic prostatectomy. J Urol. 2004;171(4):1563-6. [Crossref]  [PubMed] 
  9. Mohee A, Khan A, Harris N, Eardley I. Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB). BJU Int. 2013;111(1):106-13. [Crossref]  [PubMed] 
  10. Joussain C, Popoff M, Phé V, Even A, Bosset PO, Pottier S, et al. Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity. Neurourol Urodyn. 2018;37(2):799-806. [Crossref]  [PubMed] 
  11. Ross J, Hickling D, Maciejewski C, Coriaty R, Vigil H. Intravesical botulinum toxin: Practice patterns from a survey of Canadian urologists. Can Urol Assoc J. 2023;17(1):E15-E22. [Crossref]  [PubMed]  [PMC] 
  12. Matta R, Horns JJ, Jacobson DL, Schaeffer AJ, Wallis MC, Lau GA. National trends and outcomes in the use of intravesical botulinum toxin and enterocystoplasty among patients with myelomeningocele. Urology. 2022;166:289-96. [Crossref]  [PubMed]  [PMC] 
  13. Danforth TL, Ginsberg DA. Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics? Urol Clin North Am. 2014;41(3):445-52, ix. [Crossref]  [PubMed] 
  14. Gamé X, Castel-Lacanal E, Bentaleb Y, Thiry-Escudié I, De Boissezon X, Malavaud B, et al. Botulinum toxin A detrusor injections in patients with neurogenic detrusor overactivity significantly decrease the incidence of symptomatic urinary tract infections. Eur Urol. 2008;53(3):613-8. [Crossref]  [PubMed] 
  15. Cui Y, Wang L, Liu L, Zeng F, Niu J, Qi L, et al. Botulinum toxin-A injections for idiopathic overactive bladder: a systematic review and meta-analysis. Urol Int. 2013;91(4):429-38. [Crossref]  [PubMed] 
  16. Faure Walker N, Macpherson F, Tasleem A, Rampal T. Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: a systematic review. Neurourol Urodyn. 2023;42(1):23-32. [Crossref]  [PubMed]  [PMC] 
  17. Karsenty G, Baverstock R, Carlson K, Diaz DC, Cruz F, Dmochowski R, et al. Technical aspects of botulinum toxin type A injection in the bladder to treat urinary incontinence: reviewing the procedure. Int J Clin Pract. 2014;68(6):731-42. [Crossref]  [PubMed] 
  18. Dmochowski R, Chapple C, Nitti VW, Chancellor M, Everaert K, Thompson C, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010;184(6):2416-22. [Crossref]  [PubMed] 
  19. Herschorn S, Gajewski J, Ethans K, Corcos J, Carlson K, Bailly G, et al. Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. J Urol. 2011;185(6):2229-35. [Crossref]  [PubMed] 
  20. Gajewski JB, Schurch B, Hamid R, Averbeck M, Sakakibara R, Agrò EF, et al. An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourol Urodyn. 2018;37(3):1152-61. [Crossref]  [PubMed] 
  21. Dowson C, Khan MS, Dasgupta P, Sahai A. Repeat botulinum toxin-A injections for treatment of adult detrusor overactivity. Nat Rev Urol. 2010;7(12):661-7. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com