Injeção de toxina botulínica intradetrusora no tratamento de bexiga neurogênica refratária a anticolinérgicos: influência da urodinâmica e morfologia vesical
OBJECTIVES: To assess whether cystography and urodynamics may help predict which patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergics respond better to treatment with injection of botulinum toxin A (BTX-A) and the effectiveness and quality of life in relation to treatment. METHODS: Thirty-four patients with spinal cord injury were evaluated prospectively. All emptied the bladder by clean intermittent catheterization, had incontinence and detrusor overactivity despite the use of 40 mg or more of oxybutynin and underwent to bladder injection of BTX-A (300UI). Pretreatment evaluation included urodynamics, ultrasound, cystography and quality of life questionnaire (ICIQ - SF). Follow-up consisted of urodynamics and office visit four months after treatment. Cystography was evaluated by bladder shape, capacity and presence of diverticula. Urodynamic parameters used for assessment were maximum cystometric capacity, maximum detrusor pressure, compliance and reflex volume. RESULTS: After injection of BTX-A, 70 % of patients had good results, staying 4 months or more continents. There were significant differences in most urodynamic parameters before the procedure, in the group with good response compared to those with unsatisfactory response. Patients who showed best response were those with greater maximum cystometric capacity (p = 0.019), higher reflex volume (p = 0.041), greater compliance (p=0.043). There was no statistical difference from the maximum detrusor pressure (p=0.691). The maximum cystometric capacity (p0.720) and presence of diverticula (p>0.999). There was significant improvement in quality of life scores with the median reduction from 18 to five (p0,720) e presença de divertículos (p>0,999). Houve melhora importante do escore de qualidade de vida com redução da mediana de 18 para 5 (p<0,001), indicando satisfação com o resultado. CONCLUSÕES: Os parametros da cistografia não foram capazes de ajudar a prever a resposta a injeção de TB-A no tratamento de HDN refratária. Observou-se que a maior parte dos parametros urodinâmicos se encontravam melhores nos pacientes com boa resposta ao tratamento, exceto a PDM. Também houve melhora da maioria dos parâmetros urodinâmicos, exceto da complacência. Houve satisfação importante dos pacientes com os resultados, de acordo com o questionário de qualidade de vida
