Treatment of Neurogenic Incontinence with Botulinum Toxin A

Schurch, Brigitte; Schmid, Daniel; Stöhrer, M.

doi:10.1056/nejm200003023420918

Cited by 218 publications

(105 citation statements)

References 2 publications

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“…Some are under development and investigation such as intravesical vanilloid agents, 29 intrathecal clonidine 30,31 or botulinum A-Toxin detrusor injections. 32,33 These could be speci®c alternatives to all surgical techniques for the future.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of augmentation cystoplasty in spinal cord injury patients

Chartier-Kastler

Mongiat-Artus

et al. 2000

Spinal Cord

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Study design: Prospective monocentric follow-up study. Objectives: To assess long-term functional and urodynamic results of augmentation enterocystoplasty in spinal cord injury (SCI) patients with detrusor hyperre¯exia and re¯ex incontinence who failed to respond to conservative treatment. Settings: Department of Urology (PitieÂ -SalpeÂ trieÁ re Hospital, Paris, France), Department of Neurological Rehabilitation (Raymond PoincareÂ Hospital, Garches, France), Assistance Publique ± Hopitaux de Paris, University Paris VI and V, France. Methods: Prospective study of 17 SCI patients (four above T6 level, nine between T6 and T12, and four below T12) with history of refractory urge incontinence to pharmacotherapy. Partial cystectomy (subtrigonal for 15) was performed with Hautmann enterocystoplasty (15) or detubularized clam cystoplasty (two). Results: Mean follow-up was 6.3+3.8 years (range 1.25 ± 10.5 years). Fifteen of 17 (88.5%) patients were completely continent under self clean intermittent catheterization (CIC) (mean 4.6/day, range 4 ± 7). The remaining two patients with pudendal nerve denervation had persistent stress urinary incontinence. No operative complications were noted. Long-term complications included recurrent pyelonephritis for one patient. Maximal cystometric capacity increased from 174.1+103.9 to 508.1+215.8 ml (P50.05). Maximal end ®lling pressure decreased from 65.5+50.2 to 18.3+7.9 cm H 2 O (P50.05). Conclusion: Urodynamic evaluation and clinical assessment demonstrate long-term success of augmentation enterocystoplasty in an homogeneous population (SCI) without delayed complications in SCI patients. Spinal Cord (2000) 38, 490 ± 494

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Section: Discussionmentioning

confidence: 99%

Long-term results of augmentation cystoplasty in spinal cord injury patients

Chartier-Kastler

Mongiat-Artus

et al. 2000

Spinal Cord

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“…Botulinum toxin injections in the bladder Botulinum toxin causes a long-lasting but reversible chemical denervation that lasts for about 9 months (137)(138)(139)(140)(141)(142)(143). The toxin injections are mapped over the detrusor in a dosage that depends on the preparation used.…”

Section: 35mentioning

confidence: 99%

Forty-five-year follow-up on the renal function after spinal cord injury

et al. 2016

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“…Promising reports on the effect of botulinum-A toxin injections into the detrusor muscle to treat detrusor overactivity incontinence have been published in 2000 1,2 and the interest in this new treatment option is still increasing. 4 The currently administrated toxin dose of 300 units Botox s has been established in a previously performed dose titration study.…”

Section: Discussionmentioning

confidence: 99%

“…The first reports of botulinum-A toxin injections to treat neurogenic detrusor overactivity in spinal cord injured patients were published in 2000, 1,2 and the interest in using botulinum-A toxin for treating neurogenic incontinence is increasing. 3,4 Animal experiments revealed that injections of botulinum-A toxin into the detrusor muscle effectively block the release of acetylcholine at the presynaptic neuromuscular junction and suppress detrusor contraction.…”

Section: Introductionmentioning

confidence: 99%

Electromotive drug administration of lidocaine to anesthetize the bladder before botulinum-A toxin injections into the detrusor

2004

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Study design:Prospective, open label, cross-over-designed clinical study. Objective: To evaluate the effectiveness of an instillation of lidocaine into the bladder with versus without electromotive drug administration (EMDA) to anesthetize the bladder before botulinum-A toxin injections. Setting: Neurourology, Swiss Paraplegic Center, Balgrist University Hospital, Zurich, Switzerland. Methods: In all, 28 patients with severe neurogenic detrusor overactivity but preserved bladder sensibility were treated with botulinum-A toxin injections into the detrusor muscle. A measure of 300 u of botulinum-A toxin (Botox s ) was injected at 30 sites sparing the trigone. Prior to the injection, the bladder was anesthesized with conventional lidocaine instillation in a group of 10 patients and with lidocaine instillation enhanced by EMDA in 28 patients. The patients scored the injection pain on a 10-point rating scale. Pain rating scores with versus without EMDA enhancement of the lidocaine instillation were analyzed and the costs of the EMDA procedure were compared to general/spinal anesthesia. Results: The mean pain score of the 10 patients who underwent the injections of Botox s after conventional lidocaine instillation was 4.0 (SD 1.6). Following EMDA enhanced lidocaine instillation slight even or no pain occurred during the injections of Botox s , and the mean pain score was 0.5 (SD 0.2). Compared to spinal or general anesthesia, the local anesthesia saved around 15% of the costs. Conclusions: EMDA enhanced instillation of lidocaine enables a sufficient anesthesia of the bladder wall that ensures a painless application of the botulinum-A toxin injections into the detrusor muscle. This method may avoid general or spinal anesthesia in patients with preserved bladder sensibility. It ensures considerable cost reduction, avoids anesthesia-related risks and complications and enables the procedure on an outpatient basis.

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Treatment of Neurogenic Incontinence with Botulinum Toxin A

Cited by 218 publications

References 2 publications

Long-term results of augmentation cystoplasty in spinal cord injury patients

Long-term results of augmentation cystoplasty in spinal cord injury patients

Forty-five-year follow-up on the renal function after spinal cord injury

Electromotive drug administration of lidocaine to anesthetize the bladder before botulinum-A toxin injections into the detrusor

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