Long-term response of different Botulinum toxins in refractory neurogenic detrusor overactivity due to spinal cord injury

Abstract

Purpose To assess the response in spinal cord injured patients alternatively treated with different types and dosages of Botulinum neurotoxin type A (BoNT/A) over 15 years.Material and methods Patients who underwent first BoNT/A from 1999-2001 and practiced intermittent catheterization were included. Baseline 3-day bladder diary (BD) and urodynamics were collected. BoNT/A failure was defined when patients asked for re-injection ≤ 3 months post-treatment. Criteria for re-injection was at least one daily episode of urinary incontinence at BD. Before re-injection, patients were asked if they had reached 6 months of dryness without antimuscarinics (YES response).Results Overall, 32/60 (53.4%) “No failure” (NF) group; 16 (26.6%) “occasional failure” (OF) and 12 (20%) “consecutive failure” (CF) were included. A total of 822 BoNT/A infiltrations were performed. The mean interval from previous injection to treatment re-scheduling was 8 months. No significant differences between treatments were found within the three groups (p>0.05). The percentage of YES responses increased from 19% (AboBoNT/A 500IU) to 29 % (OnaBoNT/A 300IU) in NF, and from 18% (AboBoNT/A 500IU) to 25% (OnaBoNT/A 300IU) for OF. Five NF cases (15.6%) maintained 6 months of dryness after each injection. Among the baseline variables, only low compliance (< 20mL/cmH2O) was found as predictor for failure (p=0.006).Conclusions Long term BoNT/A for NDO did not increase failures, independent of the types of treatments and switching. Definition of failure and other criteria for continuing repetitive BoNT/A treatment is mandatory. CF was predictable for no response in earlier follow-up.

Satisfaction with Detrusor OnabotulinumtoxinA Injections and Conversion to Other Bladder Management in Patients with Chronic Spinal Cord Injury

“…Previous studies had reported that a high baseline Pdet.max can usually predict poor urodynamic outcomes, whereas low bladder compliance was a predictor of failure after detrusor Botox injection [26,27]. Similarly, the current study found patients with a high Pdet and higher BCI and BOOI displayed marked improvement in urinary incontinence after detrusor Botox injection.…”

Using Botulinum Toxin A for Treatment of Interstitial Cystitis/Bladder Pain Syndrome—Possible Pathomechanisms and Practical Issues

“…The persistence of the therapeutic effect after a single BoN-A injection in patients with LUTDs has varied among studies. In a study comparing the different types of BoNT-A injection for patients with neurogenic detrusor overactivity, approximately half of the patients (53.4%) exhibited continence at three months postinjection [74]. The mean interval of on-demand repeated injection was eight months, and no significant differences were found among types of BoNT-A injections.…”

Will repeated botulinum toxin A improve detrusor overactivity and bladder compliance in patients with chronic spinal cord injury?

“…A recent study compared onabotulinumtoxinA with abobotulinumtoxinA for NDO showed that sustainable long-tern outcomes were achieved following both treatments. However, if the efficacy was not satisfactory, switching to another type of BoNT-A did not improve the response [ 65 ].…”