Botulinum toxin A injection for the treatment of neurogenic detrusor overactivity secondary to spinal cord injury: Multi‐institutional experience in Japan

Abstract

Abbreviations & AcronymsObjectives: To examine the efficacy and safety of onabotulinumtoxinA (Botox) injection into the bladder wall for the treatment of neurogenic detrusor overactivity secondary to spinal cord injury in Japanese patients. Methods: We enrolled Japanese spinal cord injury patients with cystometrically confirmed neurogenic detrusor overactivity who experienced urinary incontinence at least once a week either because they were refractory to anticholinergics or had to discontinue treatment because of adverse events. Patients received 200 units of onabotulinumtoxinA injected into the bladder wall after a 2-week washout of anticholinergics, and urodynamic variables were assessed before and 1 month after injection. Catheterization and urinary incontinence data, as well as International Consultation on Incontinence Questionnaire -Short Form scores, were assessed before injection and every month thereafter until the cessation of treatment effects. Results: The study enrolled 19 patients (13 men, six women, age range 22-67 years). One month after injection, the mean number of urinary incontinence episodes decreased from 4.3 to 1.5 times/day (P = 0.004), and the maximum cystometric capacity increased from 100 mL to 296 mL (P = 0.0004). The rate of effective cases whose daily urinary incontinence frequency was decreased to less than 50% was 74%. The duration of efficacy without anticholinergic medication ranged from 3 to 12 months (median 8.5 months). Clinically significant adverse events were not observed. Conclusions:The present findings show the efficacy and tolerability of onabotulinumtoxinA injection for the treatment of neurogenic detrusor overactivity in Japanese spinal cord injury patients.

Editorial Comment to Botulinum toxin A injection for the treatment of neurogenic detrusor overactivity secondary to spinal cord injury: Multi‐institutional experience in Japan

“…In the present multi-institutional prospective study, Sengoku et al enrolled 19 patients with neurogenic detrusor overactivity to receive botulinum toxin injection after a period of anticholinergic washout. 7 The study's results were in line with previous studies showing significant improvements in urinary incontinence frequency (1.5 from 4.3), maximum cystometric capacity (296 from 100), maximum detrusor pressure of detrusor overactivity (33 from 70) and International Consultation on Incontinence Questionnaire scores (4 from 17) 1 month after injection. [2][3][4] However, the duration of efficacy from the treatment was found to be 50% at 8 months and 33% at 12 months, also in line with previously studies.…”

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

“…For detailed guidelines on management of AD see: 47,180 It is also possible that botulinum toxin A (Botox) can reduce the frequency and severity of AD secondary to detrusor muscle overactivity. 183,184 Typically, 200 units of Botox is injected per procedure (diluted in 15mL saline to 20U/mL), where it is injected into the detrusor muscle at 20 sites (10U per site), sparing the trigone (see clinical vignette).…”

Šlapinimosi sutrikimai po stuburo traumų ir jų gydymas botulino toksino A endovezikinėmis injekcijomis

“…Botulino toksino A efektyvumas vidutiniškai truko 8,5 mėnesio. Tyrimo duomenimis, pacientų lytis, amžius ir stuburo pažei-dimo lygis procedūros efektyvumui įtakos neturi [41].…”