OBJECTIVE
To evaluate the influence of repeated botulinum neurotoxin A (BoNT‐A) treatments on detrusor function in patients with neurogenic detrusor overactivity (DOA) due to spinal cord lesions.
PATIENTS AND METHODS
In a retrospective study, urodynamic evaluations of 27 consecutive patients with neurogenic DOA due to spinal cord lesions who received at least five BoNT‐A treatments were analysed.
RESULTS
After the first BoNT‐A treatment, bladder capacity, reflex volume, continence status and detrusor compliance were significantly improved and maximum detrusor pressure (Pdetmax) was significantly reduced. The mean number of BoNT‐A treatments was 7.1. Compared with the results of the first treatment, the incontinence rate (seven patients) and the number of patients with an elevated Pdetmax (five patients) were slightly increased after the final BoNT‐A treatment. The long‐term success rate was 74%. Every fourth patient needed a major surgical intervention. There was a significant decrease in Pdetmax before BoNT‐A treatments, indicating that detrusor contraction strength did not completely recover after treatment.
CONCLUSIONS
Our study confirmed the long‐term efficacy of repeated BoNT‐A treatments in patients with neurogenic DOA. However, in long‐term follow‐up, every fourth patient required surgical interventions. Moreover, our data give the first hint that BoNT‐A may lead to impaired detrusor contraction strength, which could influence future treatment options. Prospective studies are necessary to elucidate the impact of repeated BoNT‐A treatments on detrusor function and the interactions with future treatment options.
Study design: A series of 94 urinary bladder biopsies in spinal cord injured (SCI) patients were histopathologically and statistically analysed. Objectives: The following hypotheses were examined: (1) The number of clinical bladder infections per year in each patient does not in¯uence the histopathological type of in¯ammation of the urinary bladder; (2) The duration of the spinal cord lesion does not have a strong eect on the type of in¯ammation; (3) The dierent neurological levels (upper and lower motor neuron lesions) do not relate to a speci®c histopathology. Settings: All patients received their treatment at the Swiss Paraplegic Centre in Nottwil, near Lucerne (Switzerland). Methods: The samples were taken from the bladder fundus during endoscopic urologic operations. Histopathological standard procedures were carried out. Statistical analysis including Kruskal ± Wallis and Chi-square tests were performed. Results: Histopathological analysis showed abnormal alterations of the urinary bladder mucosa in 86 SCI-patients: (91.5%). 63 cases (67.0%) showed a chronic type and 23 cases (24.5%) showed a subacute type of in¯ammation. A normal urinary bladder was found in eight cases (8.5%). The three hypotheses were statistically not rejected. Conclusion: Results demonstrated no correlation between the number of bladder infections per year, the period since injury, the neurologic level of the spinal cord lesion and the histopathology of the urinary bladder mucosa.
Objective: Sphincterotomy is a well-established therapeutic option in male patients with neurogenic bladder dysfunction and detrusor-sphincter-dyssynergia due to spinal cord lesions. Indication and prediction of treatment outcome, however, are mainly based on clinical parameters. We analyzed the clinical usefulness of preoperative urodynamic evaluation for the prediction of success in patients undergoing external sphincterotomy. Materials and Methods: In a retrospective study, residual urine, retrograde perfusion pressure (RESP) and detrusor leak point pressure (DLPP) in 62 male patients with spinal cord injury were assessed before sphincterotomy. Data were compared to surgical success evaluated by postoperative DLPP and residual urine. Results: Sphincterotomy was successful in 85.4% of our patients. In multivariate analysis, both preoperative DLPP and RESP were superior to measurement of residual urine concerning prediction of surgical success. However, these differences were not statistically significant. Conclusion: To our knowledge, this is the first study to evaluate preoperative predictors for surgical success in patients undergoing sphincterotomy. Although urodynamic evaluation is strongly advised prior to surgery in patients with spinal cord lesions, it improves prediction of success only marginally.
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