Botulinum toxin in spinal cord injury patients with neurogenic detrusor overactivity

Abstract

Evidence for the efficacy and safety of intravesical onabotulinum toxin A (onabotA) injections has led to them being licensed in many countries, including Korea, for the treatment of patients with urinary incontinence due to neurogenic detrusor overactivity (NDO) resulting from spinal cord injury or multiple sclerosis who are refractory or intolerant to anticholinergic medications. OnabotA injections have an inhibitory effect on acetylcholine release for up to 10 months, with a recommended dose of 200 U. OnabotA treatment has a beneficial effect not only on urinary symptoms, but also on quality of life. Several clinical studies have shown onabotA to have better effects than placebo in achieving continence, reducing incontinence episodes, improving urodynamic parameters, and improving health-related quality of life. Urinary tract infections and postvoid residual volume are the most prevalent side effects. In patients with residual volume, clean intermittent catheterization may be necessary. In patients with spinal cord injury or multiple sclerosis, it is recommended to evaluate physical and cognitive function before intravesical onabotA injection to ensure that the patient and caregiver are able to perform catheterization if necessary. Further controlled trials should assess the optimal dose, injection technique, long-term safety of repeated injections, and optimal timing of onabotA treatment in the treatment of NDO.

Persistent urine leakage around a suprapubic catheter: the experience of a person with chronic tetraplegia

“…The gold-standard treatment for neurogenic detrusor over-activity is anticholinergic medication and intermittent self-catheterization [ 5 ]. Long-term indwelling catheterization in the bladder and associated chronic inflammation can make the bladder low compliant in spinal cord injured patients.…”

“…Muscle weakness, asthenia and constipation have been reported [ 7 ]. Cho and Kim [ 5 ] also stated that the use of onabotulinum toxin A in patients with high cervical lesions above T1 carries the risk of developing muscular weakness in the respiratory muscles. Therefore, Botulinum toxin injection should be used only when the bladder spasms are not adequately controlled by antimuscarinic drugs prescribed singly or in combination, and beta-3 adrenoceptor agonist, used alone or in addition to anti-muscarinic drug.…”

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

“…Common pharmacologic methods to assist bladder function include the use of anticholinergic agents to promote detrusor relaxation, increase the capacity of a hyperactive detrusor muscle, and promote improved urine storage ( Table 1). 13,14 They are used in both intermittent and indwelling catheter users. 3,8,15 Botulinum toxin A injections into the detrusor muscle can be recommended when anticholinergic agents are insufficient or cause intractable side effects.…”

“…Commonly used pharmacologic agents used to assist bladder function13,14 dangerously high prior to use. Complications can include the condom falling off, skin irritation, incomplete emptying, and UTIs 10.…”

Broaden and Build Up Knowledge Based on Investigative and Clinical Research

“…However, the extensive investigative and clinical research that has been conducted recently to understand the pathophysiological mechanism of DO has revealed the effectiveness of other pharmacological compounds such as mirabegron, a novel β3-adrenoceptor agonist, and botulinum toxin [1]. Evidence of the efficacy and safety of intravesical onabotulinum toxin A injections has led to their approval in many countries, including Korea, for the treatment of urinary incontinence due to neurogenic DO resulting from spinal cord injury or multiple sclerosis in patients refractory or intolerant to anticholinergic medications or mirabegron [2]. We can conclude from this that various therapeutic options are available for DO.…”