Experience with different botulinum toxins for the treatment of refractory neurogenic detrusor overactivity

Abstract

Purpose: To report our experience with the use of the botulinum toxin-A (BoNT/A) formulations Botox ® and Prosigne ® in the treatment of neurogenic detrusor overactivity (NDO). Materials and Methods:At a single institution, 45 consecutive patients with refractory urinary incontinence due to NDO received a single intradetrusor (excluding the trigone) treatment with botulinum toxin type A 200 or 300 units. Botox was used for the first 22 patients, and Prosigne for the subsequent 23 patients. Evaluations at baseline and week 12 included assessment of continence and urodynamics. Safety evaluations included monitoring of vital signs, hematuria during the procedure, hospital stay, and spontaneous adverse event reports.Results: A total of 42 patients were evaluated (74% male; mean age, 34.8 years). Significant improvements from baseline in maximum cystometric capacity (MCC), maximum detrusor pressure during bladder contraction, and compliance were observed in both groups (P < 0.05). Improvement in MCC was significantly greater with Botox versus Prosigne (+103.3% vs. +42.2%; P = 0.019). Continence was achieved by week 12 in 16 Botox recipients (76.2%) and 10 Prosigne recipients (47.6%; P = 0.057). No severe adverse events were observed. Mild adverse events included 2 cases of transient hematuria on the first postoperative day (no specific treatment required), and 3 cases of afebrile urinary tract infection. Conclusions: Botox and Prosigne produce distinct effects in patients with NDO, with a greater increase in MCC with Botox. Further evaluation will be required to assess differences between these formulations.

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

“…Gomes et al compared the use of two different BTX-A formulations (Botox® and Prosigne®). Botox treatment resulted in significantly greater increase of urodynamics parameters, and a tendency for better results in terms of continence rate (13).…”

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

“…Other BoNT/A such as NT-201 (Xeomin®) or CBTX-A distributed under several different brand names in different countries (Prosigne®, Lanzox®, Lantox®, Liftox®, and Redux®) have been studied by some authors, but evidence in literature is still lower compared to the Abo and OnaBoNT/A ( 16 ).…”

A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics

“…We note that some of these patients did not reduce the dose because they were afraid that the urinary losses would return after being continent. According to previous studies, some factors that may be related to the efficacy of BTX-A injections into the detrusor muscle include, for example, whether the doses of anticholinergics used before the procedure were considered high (refractory bladder) [7], what the optimal dose of BTX-A is [11,12], the formulations used [13,14] and the injection technique [11]. These factors may explain some of the differences observed in the results across different studies.…”