treatment failure of botulinum toxin a in patients with idiopathic overactive bladder: why do patients discontinue treatment?

Objectives: the study aimed to evaluate the long-term compliance and reasons for discontinuation of intravesical botulinum toxin a (bont-a) treatment in women with idiopathic overactive bladder syndrome (ioab). methods: all patients who had been treated with bont-a between 2004 and 2010 were invited to join a written survey in june, 2015. only women with idiopathic oab symptoms were included. the survey was designed first to assess current urinary symptoms in patients who failed bont-a treatment, and second to evaluate their experiences with bont-a and subsequent treatments. results: in total, 74 patients who discontinued btx-a treatment were identified. the response rate was 62%. the most common reasons for discontinuation of treatment were insufficient effect (37%), the need for clean intermittent self-catheterization (cisc, 13%), and urinary tract infections (uti, 9%). 17% of the patients reported that they did not want a new treatment despite good effects. after an average follow-up of 92 months, more than three quarters (76%) of the patients suffered from urgency incontinence. in most patients, incontinence had a great influence on daily life (average score of 7 on a scale of 10). during the time of this survey, 25% of the patients used drugs for their oab symptoms, 15% were referred for sacral neuromodulation, and 1 patient underwent urinary deviation. conclusions: our study provides important information on the follow-up and the reasons for discontinuation in patients with idiopathic oab. this information can be used in counselling of patients and further improvement of bont-a treatment.