Botulin-A Toxin/Dimethyl Sulfoxide Bladder Instillations for Treatment of Voiding Dysfunction Secondary to Detrusor Hyperreflexia and Detrusor Instability in Women
Rationale:
To date, the standard treatment for overactive bladder (including detrusor hyperreflexia and
detrusor overactivity) consists of oral anticholenergic medications that can have
troublesome side effects and variable efficacy. What's more, patients failing
pharmacological therapy must either live with their malady or undergo open surgery that is
irreversible and carries a prolonged convalescence. The fact remains however that treatment
for overactive bladder is necessary to help maintain quality of life and prevent upper
urinary tract deterioration. In recent years, cystoscopic-guided injection of Botulinum-A
toxin has been used as a novel method of addressing detrusor hyperreflexia and overactivity
by blocking acetylcholine transmission at the bladder. The obvious benefits of a more
targeted therapy notwithstanding, this method requires the use of a cystoscope, needle
delivery of the agent through approximately 30 separate injection sites and either regional
or topical intravesical anesthesia for peri-operative pain control. Clearly, the
identification of less invasive and more cost effective means of delivering the beneficial
effects of Botulinum-A toxin to the bladder muscle has the potential to enhance the overall
appeal of this treatment method.
Objectives:
The primary objective of this pilot study is to evaluate the safety and efficacy of direct
instillations of Botulinum-A toxin/DMSO into the bladder via a catheter system as a means of
treating women with symptoms of overactive bladder and secondary urinary incontinence. In
doing so, we will focus on estimating the percentage of women who experience an improvement
in their urinary incontinence symptoms at one month and three months following this novel
instillation technique.
Study Design:
We are proposing a single center, Phase II pilot study for this investigation. In this
proposal, 25 sterile women between 18-90 years of age with urodynamic evidence of detrusor
overactivity, hyperreflexia or symptoms of overactive bladder syndrome who lack evidence of
infection and stress incontinence will be offered bladder instillation of Botulinum-A toxin
with DMSO as a carrier agent if they have failed anticholinergic medications or cannot
tolerate the pharmacological side effects. We will use two validated measurement tools for
determining urinary incontinence severity. These measurement tools will be administered to
each women at baseline and then again at one month and three-month follow-up time points.
Our analysis will also focus on identifying and describing adverse events among these women
and estimating the percentage of women that experience a successful improvement in their
urinary incontinence symptoms.
Study Duration:
Patients will sign an informed consent and be screened for eligibility. Once determined
eligible for the study, each patient will be scheduled for baseline evaluation and
instillation of Botox/DMSO. Patients will be then followed up at one month and three
months. Patients will be removed from the study if they withdraw consent, experience one of
the study stopping criteria (in which case the entire study will stop) or when they complete
the final follow-up evaluation at three-months.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Success is any women whose quantitative symptoms score on either the Blaivas - Groutz score or the IUSS score move from the 'severe' or 'moderate' category to the 'mild' category or from the 'mild' category to the 'none' category.
1 month and 3 month post treatment
No
Steven Petrou, MD
Principal Investigator
Mayo Clinic
USA: Mayo IRB
359-06
NCT00583219
March 2006
May 2008
Name | Location |
---|---|
Mayo Clinic Jacksonville | Jacksonville, Florida 32224 |