Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008 THE JOURNAL OF UROLOGY® 441

reduced as compared to baseline (p<0.001). No local or systemic side effects have been recorded.

CONCLUSIONS: Intravesical BoNT/A represents a valuable treatment for refractory neurogenic detrusor overactivity over a long

clinical and urodynamic conditions, and a large proportion of patients reach a complete urinary continence and a remarkable control of UTI.

of neurogenic bladder.Source of Funding: None

1285EFFICACY OF REPEATED INJECTIONS OF BOTULINUM TOXIN-A IN PATIENTS WITH OVERACTIVE BLADDER AND IDIOPATHIC DETRUSOR OVERACTIVITYChristopher Dowson*, Arun Sahai, Jacques Roux, Jane Watkins, Mohammad S Khan, Prokar Dasgupta. London, United Kingdom.

INTRODUCTION AND OBJECTIVE: Botulinum Toxin-A(BTX-A) is emerging as an effective second line treatment for idiopathic detrusor overactivity (IDO). However, little is known on its longer term

of repeated intra-detrusor injections of BTX-A in patients with IDO.METHODS: Sixteen patients with proven IDO received

repeated BTX-A injections (range 2 to 4, total number of injections 45). All patient initially received 200 U BTX-A via a minimally invasive technique using local anaesthetic. Repeat injection doses were subsequently

dysfunction. Outcome was assessed using urodynamics, voiding diaries and validated quality of life questionnaires (IIQ-7 and UDI-6) at presentation and then at 4, 12 and 24 weeks after each injection. Data

second, second and third and third and fourth injections was 57.0, 52.3,

between injections 1 & 2 and 2 & 3. There is not yet enough data to

difference was found when comparing the data 12 weeks following the

detrusor volume (p=0.55), bladder compliance (p=0.065), maximum detrusor presurre (p=0.9), frequency (p=0.38), urgency (p=0.41), urge urinary incontinence (p=0.1), UDI6 (p=0.7) and IIQ7 (p=0.7). Four patients had their dose increased at subsequent injections and all showed subjective and objective improvement. Five patients had their doses reduced in an attempt to avoid intermittent self catheterisation which had resulted post treatment. Only 2 patients were able to achieve this whilst still maintaining an improvement in symptoms.

CONCLUSIONS: BTX-A appears to be effective following repeated administration in patients with IDO. OAB symptoms, QoLand urodynamic parameters improve compared to baseline following

injections in this cohort.Source of Funding:

Ltd.

1286ASSESSMENT OF URODYNAMICS AND DETRUSOR CONTRACTILITY FOLLOWING BOTULINUM TOXIN-A TREATMENT FOR OVERACTIVE BLADDERArun Sahai, Phillipa Sangster, Vinay Kalsi, Christopher Dowson*,

Dasgupta. London, United Kingdom, and Pittsburgh, PA.INTRODUCTION AND OBJECTIVE: Incomplete bladder

emptying and intermittent self catheterisation (ISC) rates following botulinum toxin-A (BTX-A) treatment for overactive bladder varies between 0-45% in published literature. To assess whether this is predictable, urodynamic and detrusor contractility parameters were assessed in patients from 2 centers.

METHODS: Sixty-seven patients (27 males, 40 females) with proven idiopathic detrusor overactivity underwent injections of 200 U

were conducted at baseline, 4 and 12-16 weeks post-injection. Detrusor contractility was assessed with projected isovolumetric pressure (PIP1) in females and bladder contractility index (BCI) in males. Symptomatic patients with post void residuals (PVR) > 150 mL were commenced on ISC. Statistical analysis was performed using Wilcoxon matched pairs and Mann-Whitney tests and receiver operator characteristic (ROC) analysis was carried out on relevant parameters.

RESULTS: Improvements in mean cystometric capacity,

raised at 4 but normalised by 12 weeks. Nineteen patients required

parameters tested including PVR were not statistically different between

incomplete bladder emptying and ISC use following 200 U BTX-A.In general, detrusor contractility variables such as PIP1 and BCI are easy to calculate with standard urodynamics and may be helpful in predicting voiding dysfunction following BTX-A treatment for patients with overactive bladder and idiopathic detrusor overactivity.

Source of Funding:

1287EFFECTS OF INTRAVENOUS OXYBUTYNIN ON BLADDER OVERACTIVITY INDUCED BY INTRAVESICAL INSTILLATION OF ADENOSINE TRIPHOSPHATE IN RATSYongtae Kim*, Sangjin Kim, Jungwoo Lee, Daekeun Kim, Hyungkon Kim, Youngwoo Son, Hongsang Moon, Hongyong Choi, Haeyoung Park, Tchun-Yong Lee, Youngnam Woo. Seoul, Republic of Korea.

INTRODUCTION AND OBJECTIVE: Adenos ine triphosphate(ATP) is released from bladder urothelium in response to stretch and may act as a sensory neurotransmitter. ATP release from the bladder urothelium is augmented in many pathophysiologic conditions, resulting in bladder overactivity. We investigated the effects of oxybutynin on bladder overactivity induced by intravesical instillation of ATP to determine if oxybutynin suppress ATP-induced bladder overactivity through antimuscarinic mechanisms.

METHODS: Under urethane anesthesia(1.2gm./kg.) cystometry(at rate of 0.04ml/min) was performed in female Sprague-Dawley rats(body weight 250 gm.). After 2 hour baseline period, protamine sulfate(10mg/ml) was instilled for 1 hour, then ATP(60mM, pH6.0) was instilled intravesically. Oxybutynin, P2X receptor antagonists

M3 muscarinic receptor selective antagonists 4-diphenylacetoxy-N-methylpiperidine methobromide(4-DAMP), M2 muscarinic receptor selective antagonists methoctramine were given intravenously when ATP-induced bladder overactivity is stable.

RESULTS: When protamine sulfate was infused intravesically,.intercontraction interval(ICI) was decreased to 79.5%, and intravesical instillation of ATP after protamine sulfate treatment further decreased ICI

protamine 476.7 ± 70.5, ATP 279.9 ± 56.8). PPADS, given intravenously,

28.0, 0.1 mg/kg 211.1 ± 33.9, 1 mg/kg 296.1 ± 43.0, 10 mg/kg 413.4 ± 63.8). Oxybutynin, given intravenously, reversed the ATP-induced ICI

µg/kg 324.8 ± 53.5, 1.0 µg/kg 421.7 ± 108.5). In contrast ATP-induced

ATP 202.9 ± 44.4, 0.1 µg/kg 227.3 ± 62.1, 0.3 µg/kg 210.6 ± 61.0, 1.0

97.2, 0.03 µg/kg 305.1 ± 98.7, 0.1 µg/kg 282.3 ± 114.9, 0.3 µg/kg 234.2 ± 74.4). Maximum voiding pressure, pressure threshold, and baseline