You have accessJournal of UrologyBladder and Urethra: Anatomy, Physiology and Pharmacology1 Apr 2011425 BOTULISM TOXIN TYPE A INJECTIONS IN THE NEUROGENIC BLADDER LESSONS THE SEVERITY OF AUTONOMIC DYSREFLEXIA IN THREE PERSONS WITH SCI DURING URODYNAMICS Cynthia Trop, Christina Yen, Giuseppe Galea, Marinella Galea, William Bauman, and Jill Wecht Cynthia TropCynthia Trop Bronx, NY More articles by this author , Christina YenChristina Yen Bronx, NY More articles by this author , Giuseppe GaleaGiuseppe Galea Bronx, NY More articles by this author , Marinella GaleaMarinella Galea Bronx, NY More articles by this author , William BaumanWilliam Bauman Bronx, NY More articles by this author , and Jill WechtJill Wecht Bronx, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.515AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Autonomic dysreflexia (AD) is caused by a massive sympathetic discharge triggered by a stimulus below the level of the spinal cord injury, commonly caused by bladder distention or irritation. It is assumed that treatment with botulism toxin A reduces the incidence of AD by reducing neurogenic detruser overactivity. The study objective was to compare changes in beat to beat mean arterial pressure (MAP) during clinical urodynamics, prior to and 6 weeks post botulism toxin A injections in three spinal cord injured individuals. METHODS Three individuals with chronic SCI (>1 yr), T3 and above had botulism toxin A injections during which three hundred units of botulism were injected under cystoscopic guidance into the bladder in 30 locations. Urodynamics were performed prior to treatment and 6 weeks post to evaluate for detrusor hyperreflexia, during which BP was monitored continuously. Data are reported as percent changes in MAP. DESIGN Interventional, prospective, observational. RESULTS All three subjects exhibited a reduction in the percent change in MAP from baseline to maximum cystometric capacity (MCC)(Table 1.0). There were no significant changes pre and post testing in volume infused or detrusor pressure at MCC. Although subjects 1 and 3 experienced AD during urodynamics both pre and post treatment, (change in MAP > 20%); the severity of the AD was greatly reduced post treatment in both cases. Subject 2 did not experience AD pre or post treatment, but change in MAP during post treatment urodynamics was reduced from change in MAP during pre treatment urodynamics. CONCLUSIONS Our preliminary findings suggest that intravesical botulism toxin A injections help alleviate elevations of blood pressure by decreasing detrusor muscle contractility. We suggest that by inhibiting acetylcholine release in the bladder membrane, botulinum toxin A injections help reduce the afferent discharge from the distended bladder, thus decreasing the incidence and severity of AD. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e171-e172 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cynthia Trop Bronx, NY More articles by this author Christina Yen Bronx, NY More articles by this author Giuseppe Galea Bronx, NY More articles by this author Marinella Galea Bronx, NY More articles by this author William Bauman Bronx, NY More articles by this author Jill Wecht Bronx, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...