Injections of Botulinum Toxin A into the detrusor to treat neurogenic detrusor overactivity secondary to spinal cord injury

Abstract

To present a comprehensive experience of botulinum toxin A (BTX-A) injected into the detrusor muscle in patients with spinal cord injuries (SCI) causing neurogenic detrusor overactivity. Three hundred units of BTX-A were injected cystoscopically into the detrusor muscle of 108 patients with neurogenic detrusor overactivity secondary to SCI at 30 different locations. Evaluations were performed before the injections and 6 weeks after, and they included determination of bladder urinary continence status, frequency/volume chart of CIC, concomitant anticholinergic medication use, Incontinence Quality of Life questionnaire (I-QOL) and patient satisfaction. Key urodynamic parameters (reflex volume, maximum detrusor pressure during voiding, detrusor compliance and maximum cystometric capacity) were analyzed at the outset and during the follow-up (6, 12 and 36 weeks) examinations. By the time of the urodynamic follow-up examinations (6, 12 and 36 weeks), the mean cystometric capacity (P < 0.05) and the mean reflex volume (P < 0.05) increased significantly, while the mean voiding pressure (P < 0.05) decreased significantly. No complications or side effects were reported. Most patients considerably reduced or even stopped taking anticholinergic drugs and were satisfied with the treatment. This retrospective study indicates that BTX-A injections into the detrusor muscle to treat neurogenic detrusor overactivity secondary to SCI are safe and valuable. Significant improvement of bladder function corresponded with continence and subjective satisfaction indicated by the treated patients.