Therapeutic effects of detrusor botulinum toxin A injection on neurogenic detrusor overactivity in patients with different levels of spinal cord injury and types of detrusor sphincter dyssynergia

Abstract

Study design: The study was designed as a single-arm clinical trial. Objectives: To investigate the therapeutic effects of detrusor botulinum toxin A (BoNT-A) treatment in patients with different levels of spinal cord injury (SCI) and types of detrusor sphincter dyssynergia (DSD). Setting: Patients with chronic suprasacral SCI and neurogenic detrusor overactivity (NDO) were treated with 200-U BoNT-A detrusor injection in a tertiary university hospital in Taiwan. Methods: Outcome assessment of urodynamic parameters and therapeutic satisfaction were performed at 3 and 6 months among patients with different demographics, SCI levels and types of DSD. The treatment outcomes were assessed by changes in Urogenital Distress Inventory 6-item short form (UDI-6), quality of life (QoL) index and detrusor pressure at maximum flow rate (Pdet.Qmax). Results: A total of 38 patients with a mean age of 40.1±12.4 years and median duration of SCI of 10.3 years were enrolled. Satisfactory response was reported in 23 (60%) patients. Significant improvements in the UDI-6 and QoL were reported and significant increases of cystometric bladder capacity and post-void residual were noted in overall patients after treatment. Patients with different clinical demographics and urodynamic parameters had similar treatment outcomes and UDI-6 scores. In 11 patients receiving repeat injections of 300 U of BoNT-A after failure of a previous 200 U injection, the treatment outcomes were not significantly different, except that the PdetQmax at 6 months were higher in the group that received 200 U of BoNT-A. Conclusion: Patients with different SCI levels or DSD types had similar treatment outcomes after detrusor 200 U BoNT-A injections for NDO.

Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

“…[1][2][3] Neurogenic detrusor overactivity (NDO), elevated intravesical pressure, reflux, elevated post void residuals, commonly found in SCI population, increase the risk of UTI. 4,5 Detrusor botulinum toxin A (BoNTA) injection is an effective method to treat NDO and decrease detrusor pressure, [6][7][8][9] but whether this method can suppress UTI is still in dispute and there was rare report. 7,8,10 In this study, we explored the relationship between UTI and detrusor BoNTA injection in male inpatients with NDO caused by SCI.…”

Patient reported outcomes measures in neurogenic bladder and bowel: A systematic review of the current literature

“…Of the 122 abstracts screened, 56 full text studies were assessed and subsequently five studies were excluded (4 studies with no QoL‐related results and 1 study with incomplete results). The 51 articles included a total of 14,262 patients …”

Current and potential urological applications of botulinum toxin A

“…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. 82 In a study of 72 patients with NDO owing to SCI who received BoNTA injections into the detrusor, 67% were still actively undergoing repeat BoNTA injections at the time of publication, and 90% of these patients would consider continuing BoNTA as a longterm treatment for the next 5 years, indicating a high level of satisfac tion among patients receiving this treatment.…”