A pilot study assessing the feasibility and effectiveness of amniotic bladder therapy in patients with neurogenic detrusor overactivity

Abstract

Neurogenic detrusor overactivity (NDO) is characterized by involuntary detrusor contractions that often occur following spinal cord injury (SCI). In addition, patients with SCI above T6 are at risk for autonomic dysreflexia (AD). Amniotic membranes (AM) are used for the management of wound healing in multiple medical disciplines. Thus, this study aims to evaluate the efficiency of amniotic bladder therapy (ABT) in managing NDO, specifically in patients with SCI. The patients received intra-detrusor injections under general anesthesia of 100 mg micronized AM (Clarix Flo) diluted in 10 mL 0.9% preservative-free sodium chloride. Clinical evaluations, including maximum detrusor pressure, maximum cystometric capacity, and frequency of AD, were conducted, alongside the completion of questionnaires (Qualiveen questionnaire) preoperatively and postoperatively at weeks 2, 4, 8, and 12. Eight consecutive patients with an average age of 39.6 ± 13.6 years were included. After ABT, a significant decrease in the severity of urinary tract symptoms was observed based on the Qualiveen questionnaire: 3.9 ± 0.17 at baseline to 2.9 ± 0.21 at week 2, 2.1 ± 0.53 at week 4, and 1.4 ± 0.20 at week 8 (P < 0.01). Improved clinical symptoms were associated with a decreased maximum detrusor pressure, increased maximum cystometric capacity, and reduced frequency of AD. In conclusion, we investigated ABT as a potential treatment option for NDO associated with SCI. Further investigations are warranted to validate the effectiveness of ABT in this patient population and determine treatment durability.