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Area of Science:

  • Gerontology
  • Urology
  • Pharmacology

Background:

  • Bladder dysfunction, impacting urine storage and emptying, is prevalent in aging populations.
  • Conventional treatments for refractory lower urinary tract symptoms (LUTS) often lack efficacy or cause intolerable side effects in older adults.
  • Botulinum toxin type A (BoNT-A) is an established treatment for refractory LUTS in the general population.

Purpose of the Study:

  • To review the efficacy and safety of intravesical BoNT-A for bladder dysfunction specifically in patients aged 65 years and older.
  • To evaluate BoNT-A's utility in managing storage and voiding dysfunctions in the geriatric population.
  • To assess the risk-benefit profile of BoNT-A in older adults with refractory bladder conditions.

Main Methods:

  • Systematic review of studies investigating BoNT-A for bladder dysfunction in adults aged ≥65 years.
  • Analysis of clinical response and adverse events (AEs) associated with intravesical BoNT-A injections.
  • Comparison of BoNT-A efficacy and safety in older adults versus younger populations.

Main Results:

  • Intravesical BoNT-A demonstrates comparable efficacy to younger adults for idiopathic overactive bladder in older patients.
  • Positive clinical responses are observed in older adults with storage dysfunction, including those with neurological comorbidities.
  • Common AEs include increased post-void residual urine, acute urinary retention, and urinary tract infections; age is not a primary determinant of AEs.
  • Evidence for BoNT-A in treating voiding dysfunction in older adults is limited.

Conclusions:

  • BoNT-A is a viable treatment option for older adults with refractory bladder storage dysfunction, offering good efficacy with manageable local AEs.
  • Clinicians must weigh the therapeutic benefits of BoNT-A against potential local adverse events in this vulnerable patient group.
  • Further research is needed to establish BoNT-A's role in managing voiding dysfunction in the elderly.