Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects

Abstract

Study design: Systematic review. Objective: To evaluate effectiveness and adverse effects of botulinum toxin (BTX) for treatment of urinary incontinence (UI) due to detrusor overactivity (DO). Methods: Randomized controlled trials published in English before November 2006 were included if they enrolled subjects with UI caused by DO and reported incontinence outcomes. Results: Three trials totaling 104 subjects with DO refractory to antimuscarinic treatment were included. Two BTX-A trials enrolled primarily patients with NDO secondary to spinal cord injury (SCI) (93%). BTX-A decreased daily UI episodes compared to placebo but the reductions were only significantly different at a few of the time intervals during 24 weeks of follow-up. BTX-A was superior in reducing daily UI episodes in SCI subjects compared to intravesical resiniferatoxin at 12 and 18 months after injections. A small crossover study found BTX-B significantly more effective than placebo in reducing weekly UI episodes in subjects with predominately idiopathic DO. Adverse events (AEs) in BTX-A-treated subjects included urinary tract infection, pain at the injection site, hematuria and autonomic dysreflexia. Four subjects treated with BTX-B reported autonomic AEs. Conclusions: BTX may improve UI for subjects with refractory DO. The preferred dose and type of BTX is not known. Long-term efficacy and safety remain unclear and require conduct of larger RCT using standardized and validated clinical outcomes measures.

Prevention of recurrent autonomic dysreflexia: a survey of current practice

“…Nonetheless, botulinum toxin, which blocks neuromuscular transmission by inhibiting the release of acetylcholine from presynaptic nerve terminals, appears effective in the treatment of overactive bladder [33,34]. AD may be provoked by botulinum toxin either during the botulinum intramuscular injection into the detrusor muscle [35,36] or in theory by a distended bladder that is not properly catheterized by the patient. In patients with SCI, this procedure is typically done after intravesicular lidocaine infusion or with spinal anesthesia to prevent procedure-related AD.…”

Current and potential urological applications of botulinum toxin A

“…77 Minor adverse events such as UTI, pain, haematuria and autonomic dysreflexia sometimes occurred after injections. 78 The therapeutic effects of BoNTA injections into the detrusor in patients with NDO owing to SCI or multiple sclerosis are not affected by the concomitant use of anticholinergics, aetiology of the NDO or by dif ferent lesion levels. 80,81 Significantly greater improve ments in incontinencerelated symptom scores (mean change in UDI6 score 5.9 versus 0.64; P <0.0001 in patients receiving detrusor or urethral injections, respectively) and overall treatment satisfaction (IIQ7 score 3.43 versus 1.88; P = 0.038 in patients receiving detrusor or urethral injections, respectively) were noted in patients with NDO and DSD owing to SCI who received 200 units of BoNTA injected into the detrusor than in those who received 100unit injections into the urethra.…”

“…[85][86][87] Autonomic dysreflexia after injection is a rare adverse event in these patients. 78,90,91 Postinjection antibiotic prophylaxis and CIC in patients with increased PVR volume are often necessary.…”

Managing the urinary tract in spinal cord injury

“…[17] However, numerous case series have demonstrated the efficacy of the drug and reports are now emerging that suggest that a long-term program of regular re-injections is an acceptable alternative for some SCI patients who are keen to avoid major surgical procedures. [18]…”