Editorial comment on: Complete continence after botulinum neurotoxin type a injections for refractory idiopathic detrusor overactivity incontinence: patient-reported outcome at 4 weeks

In the present article, Khan and co-authors investigated the patient-reported continence rate after the first intradetrusorial injection of botulinum A toxin (BoNTA) in the treatment of idiopathic detrusor overactivity (IDO) [1]. They found that intradetrusorially injected BoNTA not only improved frequency of micturition and urinary urgency but also eliminated urge incontinence in >50% of patients at 4 wk after treatment. As a complication, 39% of these patients required clean intermittent self-catheterization (CISC) to empty their bladders completely after treatment. The main contribution of the present article relies on the use, for the first time, of a validated questionnaire in evaluating the response of IDO patients to BoNTA treatment. Only self-administered validated questionnaires can exactly evaluate the extent to which patients are affected by their symptoms and whether those symptoms are alleviated by a particular treatment. The major result consists of the fact that all of the patients in the study were refractory to or could not tolerate the side effects of anticholinergic treatment. Thus, the high continence rate is really impressive, as it was obtained in subjects with more severe symptoms. Nevertheless, a question still remains about which dose of BoNTA has the main effect with the lowest CISC rate. This issue is important for future research in this field of application. In all of these respects, the present article represents an important contribution to the growing literature regarding the use of BoNTA in functional urology.