Disease-Specific Outcomes of Botulinum Toxin Injections for Neurogenic Detrusor Overactivity

Abstract

Intradetrusor injection of botulinum toxin A (BTX-A) is an effective option in the management of patients with neurogenic detrusor overactivity (NDO) who do not respond to or tolerate oral pharmacologic agents. There is level I evidence that intradetrusor injection of onabotulinumtoxinA for the treatment of refractory NDO in patients with multiple sclerosis and spinal cord injury is associated with a significantly greater achievement of patients' goals and improved performance in urodynamic studies than results with placebo. Only pilot studies or small case series support the use of BTX-A for NDO in patients with Parkinson's disease (PD) and cerebrovascular accident (CVA). BTX-A seems to be effective in children with myelomeningocele (MMC) but this statement is not supported by high level of evidence.

A Review of Botulinum Toxin A for the Treatment of Neurogenic Bladder

“…Although many injection templates have been proposed, there is currently no strict consensus. The majority include injections to the lateral walls and base, with or without trigone of the bladder . Some propose to avoid dome injections to prevent possible intraperitoneal injection of BoTA .…”

“…Neurogenic detrusor overactivity (NDO) most often occurs with suprapontine and cerebral cortex insults, including stroke, multiple sclerosis (MS), and Parkinson disease but can also occur with suprasacral spinal cord injury (SCI) (Table ). Symptoms include urinary urgency, frequency, nocturia, and incontinence, which negatively impact quality of life in many patients .…”

“…Neurogenic detrusor overactivity (NDO) most often occurs with suprapontine and cerebral cortex insults, including stroke, multiple sclerosis (MS), and Parkinson disease but can also occur with suprasacral spinal cord injury (SCI) (Table ). Symptoms include urinary urgency, frequency, nocturia, and incontinence, which negatively impact quality of life in many patients . Diagnostic findings on urodynamics include impaired detrusor compliance, high detrusor leak point pressure, high amplitude detrusor contractions, uninhibited detrusor contractions, and high PVR volume .…”

“…Classically, treatment strategies have aimed at symptomatic relief as well as reduction in clinical sequelae including urinary tract infection (UTI) and renal deterioration from elevated bladder pressures and urine reflux . Prior to U.S. Food and Drug Administration (FDA) approval of intradetrusor BoTA injections for the treatment of NDO and DSD described below, treatment options included pharmacotherapies (antimuscarinics [AMs], alpha‐blockers), assisted bladder drainage (intermittent catheterization, suprapubic catheterization, chronic indwelling Foley catheter), neuromodulation, surgical intervention such as sphincterotomy, urinary diversion or bladder augmentation, or a combination approach.…”

Efficacy and safety of intradetrusor onabotulinumtoxinA injection for managing paediatric non-neurogenic overactive bladder: A prospective case-series study

“…OnabotulinumtoxinA (Botox®; Allergan Inc., Dublin, Ireland) is a type A neurotoxin derived from Clostridium botulinum that is approved as a treatment for UI in patients with neurogenic detrusor overactivity secondary to multiple sclerosis or sub-cervical spinal cord injury who are not adequately treated by antimuscarinics [9]. Intradetrusor Botox (IDB) injection is an effective option for managing patients with neurogenic detrusor overactivity who do not respond to or tolerate oral pharmacological agents [10] and patients whose symptoms are refractory to conventional therapy [11].…”