Botulinum toxin: A potential alternative to current treatment of neurogenic and idiopathic urinary incontinence due to detrusor overactivity

Objective: To analyze and report the current data on the treatment of both neurogenic and idiopathic detrusor overactivity with Botulinum toxin.Methods: Literature review using Pub‐Med and Medline from 1990 until June 30, 2006.Results: Case series of patients with neurogenic detrusor dysfunction (NDD) and idiopathic detrusor overactivity (IDO) range from 15 to 200 patients with follow up from 12 to 36 weeks post‐treatment. Significant improvements in cystometric bladder capacity, reflex volume at first urge to void, and bladder compliance are seen in nearly all patients. Approximately 50% of NDD patients achieved urinary continence and almost all had improvement in bladder control up to 36 weeks following treatment. Patients with IDO with urgency alone or with incontinence also had urodynamic as well as symptom improvement. Approximately 75% of patients with IDO and incontinence are dry at 12 weeks post‐treatment. Urgency disappears on average in two thirds of patients. Quality of life scores also shows significant improvement for all groups.Conclusion: Botulinum toxin‐A has emerged as a promising option for the treatment of neurogenic and refractory idiopathic detrusor overactivity. Studies to date have shown that not only is this treatment effective at decreasing urinary symptoms and incontinence, as well as improving potentially dangerous urodynamic measures, but it is also minimally invasive, reversible and safe. Questions over proper dosing and dilution, number of injection sites, and re‐injection rates remain to be answered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135676/1/ijgo305.pd

The use of graft materials in vaginal pelvic floor surgery

ObjectiveTo review recent literature on graft materials used in vaginal pelvic floor surgery.MethodsA Pubmed‐search (“anterior vaginal wall” or “cystocele”), (“posterior vaginal wall” or “rectocele”) and (“vaginal vault” or “pelvic prolapse”) and (“mesh” or “erosion” or “graft” or “synthetic”) from 1995 to 2005 was performed; recent reviews [Birch C. The use of prosthetics in pelvic reconstructive surgery. Best Pract Res Clin Obstet Gynaecol 2005;19:979–91 [1]; Maher C, Baessler K. Surgical management of anterior vaginal wall prolapse: an evidence‐based literature review. Int Urogynecol J Pelvic Floor Dysfunct 2005 (May 25) [Electronic Publication] [2]; Maher C, Baessler K. Surgical management of posterior vaginal wall prolapse: an evidence‐based literature review. Int Urogynecol J Pelvic Floor Dysfunct 2006;17:84–8 [3]; Altman D, Mellgren A, Zetterstrom J. Rectocele repair using biomaterial augmentation: current documentation and clinical experience. Obstet Gynecol Surv 2005;60:753–60 [4]] were added.ResultThere are few prospective randomized trials that prove the benefit of implanting grafts in vaginal pelvic floor surgery. Many articles are retrospective case series with small sample sizes or incomplete outcome variables. Serious complications such as erosions are often not mentioned. Inconsistent or unclear criteria for anatomic cure make it difficult to compare outcomes. Quality of life issues such as dyspareunia, urinary or bowel symptoms are often ignored.ConclusionDue to a lack of well‐designed prospective randomized trials, recommendations for using graft materials in vaginal reconstructive surgery cannot be made. At this time, grafts should have limited use in a carefully selected patient population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135429/1/ijgo279.pd