Botulinum Toxin in Neurogenic Detrusor Overactivity

Abstract

PurposeTo evaluate the effects of botulinum toxin on urodynamic parameters and quality of life in patients with neurogenic detrusor overactivity.MethodsThirty four adult patients with spinal cord injury and detrusor overactivity were selected. The patients received 300 units of botulinum toxin type A. The endpoints evaluated with the episodes of urinary incontinence and measured the maximum cystometric capacity, maximum amplitude of detrusor pressure and bladder compliance at the beginning and end of the study (24 weeks) and evaluated the quality of life by applying the Qualiveen questionnaire.ResultsA significant decrease in the episodes of urinary incontinence was observed. All urodynamic parameters presented a significant improvement. The same was observed in the quality of life index and the specific impact of urinary problems scores from the Qualiveen questionnaire. Six patients did not complete the study, two due to incomplete follow-up, and four violated protocol and were excluded from the analyses. No systemic adverse events of botulinum toxin type A were reported.ConclusionsA botulinum toxin type A showed a significantly improved response in urodynamics parameters and specific and general quality of life.

Novel botulinum neurotoxin-A tibial nerve perineural injection to alleviate overactive bladder symptoms in male rats

“…According to our current understanding, BoNT-A exhibits only transient effects that last several months, before ultimately disappearing. Hence, the current treatment paradigm dictates regular reinjection of BoNT-A (D’ancona et al 2012 ; Jhang and Kuo 2018 ; Chen and Kuo 2020 ; Egeo et al 2020 ).…”

“…Such a change can be brought about when BoNT-A acts indirectly on the target, in contrast to the direct effect where the inhibited release of ACh is first temporarily offset by axon arborization and then ultimately reversed by the return of functionality (Liao and Kuo 2015 ; Lin et al 2019 ; Matak et al 2019 ; Jiang et al 2020 ; Kaya et al 2020 ; Jung et al 2021 ). By acting indirectly, the therapeutic strategy may circumvent this reversibility by inducing a long atrophic change to the target of the nerve, and not directly to the nerve itself (Welch et al 2000 ; Waseem et al 2011 ; D'ancona et al 2012 ; Park and Park 2017 ; Salari et al 2018 ).…”

The Role of OnabotulinumtoxinA in Urology: What Is the Next Step?

“…However, it has adverse effects and requires repeated periodic injections. Some of its adverse effects include hematuria, urinary tract infection, and increased postvoid residual volume [ 1 ]. Some patients are reluctant to undergo repeated BoTN-A injections leading to an increase in dropout rates.…”