Efficacy of botulinum‐A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: An objective and subjective analysis

Schulte-Baukloh, Heinrich; Schobert, J; Stolze, Thomas; Stürzebecher, Burkard; Weiss, Catarina; Knispel, Helmut H.

doi:10.1002/nau.20153

Cited by 80 publications

(42 citation statements)

References 31 publications

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“…1 Treatment of DSD and improvement of QoL have many aspects, including medical or surgical procedures, however, most types of management do not achieve a high success rate. 2 In the era of BoNT-A, it is possible to use intradetrusor injection to decrease detrusor contractility [5][6][7] and urethral injection to reduce urethral resistance, 3,4,[8][9][10][11][12][13] or to combine intradetrusor and urethral injections to achieve these desired goals. 19 BoNT-A was at first used as a urethral sphincter injection to treat DSD in SCI patients who do not desire surgery or are unable to perform CISC.…”

Section: Discussionmentioning

confidence: 98%

“…3,4 Intradetrusor injection of 200-300 units of BOTOX can reduce detrusor contractility, improve bladder compliance and restore urinary continence in DO. [5][6][7] In 1988 Dykstra et al 8 first reported the BoNT-A injection into the external sphincter in treatment of DSD. The other researchers also demonstrated the therapeutic effects of transperineal or transurethral BoNT-A injections on voiding dysfunction in patients with DSD.…”

Section: Introductionmentioning

confidence: 99%

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Satisfaction with urethral injection of Botulinum Toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion

Kuo

2008

Neurourology and Urodynamics

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Satisfaction with urethral injection of Botulinum Toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion

Kuo

2008

Neurourology and Urodynamics

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“…Therapeutic options for storage symptoms vary and they include, with or without associated clean intermittent self-catheterization, conservative treatments such as anticholinergic drugs -although the published data provide limited evidence for their efficacy in MS [4,5]. In patients with severe bladder overactivity unresponsive to anticholinergics there is evidence for the use of bladder injections of botulinum toxin A [6,7] and also emerging evidence on the use of cannabinoids [8] and tibial nerve stimulation [9]. Surgical procedures, which have been advocated with varying success [10], are a last resort being irreversible, with a risk of major operative morbidity and long-term consequences; they include augmentation cystoplasty [11], in which the bladder is transected and repaired with a patch of ileum isolated from the small intestine, and urinary diversion [12].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

Andretta

Simeone

Ostardo

et al. 2014

Journal of the Neurological Sciences

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Objective: Bladder dysfunctions are common in multiple sclerosis (MS) often causing the most distressing symptoms. The aim of this paper was to evaluate the effectiveness of sacral nerve modulation (SNM) in this disease. Methods: We conducted an observational retrospective survey in 17 patients treated with SNM in the north-east of Italy, all complaining of bladder symptoms (storage in 41%, voiding in 24%, mixed in 35%) unresponsive to conventional therapies, with a mean follow-up of 52 ± 26 months and mean Expanded Disability Status Scale score of 5.8 ± 1.8. Results: 75% of patients reported significant and lasting improvement in bladder symptoms and in quality of life. We observed a statistically significant improvement in frequency, urgency, number of pads, residual volumes, number of catheterizations and in the voided volumes. In 5 out of 6 cases with mixed symptoms the stimulation was discontinued (device totally explanted or turned off) after a mean time of 66 months (range 10-84 months) after the implant, for disease progression or loss of efficacy. Conclusion: SNM could be an option in very selected cases of storage and voiding symptoms refractory to conservative treatments caused by a stable or slowly progressive MS considering its minimal invasiveness and reversibility. The poor results observed suggest avoiding this therapy in mixed symptoms and in cases of advanced disability.

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“…Reports focused on the use of BTX-A bladder injection therapy in NDO due to MS are sparse (18). In three studies, clinical and urodynamical efficacy of BTX-A therapy in patients suffering from NDO in MS has been shown (19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

et al. 2011

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Purpose: Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. Materials and Methods: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). Results: 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). Conclusions: Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anticholinergic drugs fail to reduce NDO. Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system. The lesions occur in different time and localization in subcortical areas, brain stem and spinal cord. The disease has varied clinical presentations (1). Bladder and urethra dysfunction are very common. Detrusor overactivity is the most common urodynamic sign. It is observed in 44% (2) to 81% (3) of patients. Detrusor sphincter dyssynergia is associated with overactive detrusor in 93% of cases (2).Detrusor overactivity is often associated with overactive bladder, defined by urgency, possibly associated with urge incontinence, daytime frequency, and nocturia (4). These symptoms significantly alter the quality of life (5). Urological complications including hydronephrosis, vesicoureteral reflux, urosepsis, and urolithiasis (6) occur in 12% of the patients who suffer from neurogenic detrusor overactivity (NDO) and MS (7). The rate NeurourologyInternational Braz J Urol

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Efficacy of botulinum‐A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: An objective and subjective analysis

Abstract: BTX-A detrusor injections are very effective in the treatment of drug-resistant OAB symptoms in MS patients as reflected in urodynamic measurements and in patient satisfaction. Build up of residual urine remains a problem of which patients must be informed.

Cited by 80 publications

References 31 publications

Satisfaction with urethral injection of Botulinum Toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion

Satisfaction with urethral injection of Botulinum Toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion

Usefulness of sacral nerve modulation in a series of multiple sclerosis patients with bladder dysfunction

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

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