Botulinum Toxin Type A Injections Into the Trigone to Treat Idiopathic Overactive Bladder do Not Induce Vesicoureteral Reflux
Bibliographic record
Abstract
PURPOSE: We assessed the generation of vesicoureteral reflux before and after injection of botulinum toxin A into the trigone of patients with nonneurogenic overactive bladder, and evaluated its short-term efficacy. MATERIALS AND METHODS: Adults with nonneurogenic overactive bladder resistant to behavioral treatments, pelvic floor exercises, medication and neuromodulation were included in the study. The initial evaluation (history, physical examination, 3-day urinary diary, V8 score, flowmetry and post-void residual) was repeated 6 weeks after botulinum toxin A injection. Videourodynamic study was performed 1 hour before injection and 6 weeks later. Botulinum toxin A (200 units) was injected into the detrusor in 10 sites over the bladder base including the trigone. The primary outcome was the presence or absence of vesicoureteral reflux before and 6 weeks after botulinum toxin A injection. The secondary outcomes were clinical and urodynamic parameter changes. Values were compared using the Wilcoxon test. RESULTS: A total of 12 women were enrolled in the study (median age 76 years). The duration of symptoms was 7.5 years. One patient was excluded from analysis because of a urinary tract infection. There were 10 women with no vesicoureteral reflux at baseline and 1 had bilateral vesicoureteral reflux (grade 2 right, grade 1 left). At 6 weeks there was no induced vesicoureteral reflux and the patient with vesicoureteral reflux at baseline showed no change in vesicoureteral reflux grade. No local or systemic side effects related to botulinum toxin A were reported. In terms of efficacy, at direct questioning 6 weeks after treatment 4 of 11 patients reported an improvement that made them ask for another injection. CONCLUSIONS: Botulinum toxin A injection into the trigone does not induce de novo vesicoureteral reflux in patients with nonneurogenic overactive bladder. The therapeutic value of this approach remains to be confirmed and compared to other injection designs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".