Long-term discontinuations of botulinum toxin A intradetrusor injections for neurogenic detrusor overactivity: a multicenter study

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PurposeData on long-term outcomes of intradetrusor injections of botulinum toxin A (BTX-A) for neurogenic detrusor overactivity (NDO) are lacking. The aim of the present manuscript was to assess the outcomes of intradetrusor injections of BTX-A for NDO after more than 10 years of follow-up. MethodsA retrospective chart review of all consecutive neurological patients who had received either onabotulinumtoxin A or abobotulinumtoxin A intradetrusor injections for NDO between January 2002 and November 2007 at three academic centers, was performed. The primary outcome measure was 10 years discontinuation rate. Other outcomes of interest were: failure, reasons for discontinuation and subsequent treatments of NDO. Discontinuation-free and failure-free survivals were estimated using Kaplan-Meier analyzes. Results140 patients were included in the study. Ten-year discontinuation-free survival and failure-free survival rates were 49.1% and 73% respectively. The most common reason for discontinuation was failure (43.7%; primary and secondary in 17.2% and 26.5% of cases respectively). Secondary failure occurred after a median number of 8 injections and a median time of 80.1 months from the first injection. Other reasons for discontinuation were: patient’s decision (28.1%), non BTX-A related improvement of urinary incontinence (14.1%), progression of the neurological condition (12.5%) and adverse event (1.6%). Discontinuation-free survival was significantly poorer in spina bifida patients compared to patients with multiple sclerosis or spinal cord injury (p= 0.02). ConclusionsOver a half of NDO patients discontinue intradetrusor BTX-A within the first 10 years after the first injection. Spina Bifida patients are at high risk of discontinuation.