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The effect of spinal cord-injury level on the outcome of neurogenic bladder
treatment using OnabotulinumtoxinA
#MMPMID26229318
Al Taweel W
; Alzyoud KM
Urol Ann
2015[Jul]; 7
(3
): 320-4
PMID26229318
show ga
AIM: The aim was to report the effectiveness and safety OnabotulinumtoxinA
(Botox, Allergan, Inc., Irvine, CA, USA) intradetrusor injections in spinal
cord-injured (SCI) patients with refractory neurogenic detrusor overactivity. And
to assess the result based on SCI level. MATERIALS AND METHODS: We reviewed the
chart of 103 patients with neurogenic bladder secondary to SCI at the rehab
center who received OnabotulinumtoxinA in our Neurourology Department for
treatment of lower urinary tract symptoms between January 2007 and December 2013.
All patients had a clinical examination, urinalysis, and an urodynamic study at
baseline and 3 months after treatment as well as a visual analogue scale (VAS;
range scale: 0-10) and a bladder diary checked for 3 days. 300 IU of
OnabotulinumtoxinA, detrusor muscle injections were performed in 30 sites under
cystoscopic guidance. Outcome measures included frequency of urge urinary
incontinence collected by bladder diaries; changes in urodynamic parameters such
as maximum cystometric bladder capacity, reflex volume, maximum detrusor
pressure; side-effects; antimuscarinic drug consumption and quality of life (QOL)
measured with VAS. RESULTS: The study includes 32 female and 71 male with a mean
patient age of 29 years (range: 18-56 year). The effect of Botox injection on
bladder function was observed within 1-2 week after treatment. The urodynamic
parameters were improved significantly after treatment compared with baseline
values. There were significant reductions in the frequencies of incontinence
episodes after treatment as seen in the voiding diary. A significant improvement
in patient satisfaction was found after treatment which was expressed on the VAS
assessment, with an improvement of the mean of 3 points. Patients with thoracic
and lumbar injury have better result compare to cervical injury patients. The
earliest recurrence of clinical symptoms was at 10 weeks. Overall, the mean
duration of symptomatic improvement was 8 (2.5-21) months. CONCLUSION:
Intradetrusor onabotulinumtoxinA injections are an effective and well-tolerated
treatment for neurogenic overactive bladder that will increase patient
satisfaction and improve QOL with persisted clinical efficacy for more than 8
months.
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