Frontiers in the Clinical Applications of Botulinum Toxin A as Treatment for Neurogenic Lower Urinary Tract Dysfunction

Jiang, Yuan‐Hong; Chen, Sheng‐Fu

doi:10.5213/inj.2040354.177

Cited by 13 publications

(18 citation statements)

References 98 publications

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“…It can also track longitudinal trends and includes an automatic voiding diary for daily usage. This smartphone application might improve the shortcomings of current voiding diaries, such as incomplete records with missing values and low compliance [ 19 ]. In this study, we developed an automatic reading algorithm using ML to carry out mobile acoustic UFM.…”

Section: Discussionmentioning

confidence: 99%

Development of an Automatic Interpretation Algorithm for Uroflowmetry Results: Application of Artificial Intelligence

2022

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Purpose: To develop an automatic interpretation system for uroflowmetry (UFM) results using machine learning (ML), a form of artificial intelligence (AI).Methods: A prospectively collected 1,574 UFM results (1,031 males, 543 females) with voided volume>150 mL was labelled as normal, borderline, or abnormal by 3 urologists. If the 3 experts disagreed, the majority decision was accepted. Abnormality was defined as a condition in which a urologist judges from the UFM results that further evaluation is required and that the patient should visit a urology clinic. To develop the optimal automatic interpretation system, we applied 4 ML algorithms and 2 deep learning (DL) algorithms. ML models were trained with all UFM parameters. DL models were trained to digitally analyze 2-dimensional images of UFM curves.Results: The automatic interpretation algorithm achieved a maximum accuracy of 88.9% in males and 90.8% in females when using 6 parameters: voided volume, maximum flow rate, time to maximal flow rate, average flow rate, flow time, and voiding time. In females, the DL models showed a dramatic improvement in accuracy over the other models, reaching 95.4% accuracy in the convolutional neural network model. The performance of the DL models in clinical discrimination was outstanding in both genders, with an area under the curve of up to 0.957 in males and 0.974 in females.Conclusions: We developed an automatic interpretation algorithm for UFM results by training AI models using 6 key parameters and the shape of the curve; this algorithm agreed closely with the decisions of urology specialists.

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Section: Discussionmentioning

confidence: 99%

Development of an Automatic Interpretation Algorithm for Uroflowmetry Results: Application of Artificial Intelligence

2022

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“…Detrusor Botox injections can also decrease the occurrence of AD in SCI patients, even after augmentation enterocystoplasty. In addition, repeated detrusor Botox injections can also reduce UTI episodes and preserve renal function [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury

Chen

Lee

Kuo

2022

JCM

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Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.

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“…The expectation for intradetrusor injection of BoNT-A for reducing urinary tract dysfunction (LUTD) would be to decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations [ 1 ]. Therefore, researchers investigated the application of BoNT-A to manage the detrusor hyperreflexia (i.e., nDO) and UUI, which both originated from upper motor neuron syndrome, as seen in patients with Parkinson’s disease (PD), post-stroke, and early dementia [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Proper evaluation of micturition dysfunction in these patients is dependent on urodynamic diagnosis combined with imaging and pressure flow studies. Some patients may have concurrent detrusor underactivity, bladder neck dysfunction, and pseudodyssynergia (delay in striated sphincter relaxation or unrelaxing) [ 2 , 4 , 5 ]. Effective management of LUTD in these patients may benefit psychosocial and health-related quality of life and decrease social isolation, anxiety, depression, and fall risk.…”

Section: Introductionmentioning

confidence: 99%

Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson’s Disease or Post-Stroke

Hsu

Lee

et al. 2023

Toxins

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Botulinum toxin A (BoNT-A) paralyzes muscle by blocking acetylcholine release at the synaptic junction. BoNT-A has shown its therapeutic effects in neurological disorders such as Parkinson’s disease (PD) and post-stroke spasticity. A high proportion of patients with PD and post-stroke develop neurogenic detrusor overactivity (nDO) and then develop urinary incontinence and overactive bladder (OAB) symptoms. This study aimed to disclose the safety and efficacy of BoNT-A injection in treating bladder and voiding dysfunction in PD and post-stroke patients by reviewing the current evidence. At present, intradetrusor injection of BoNT-A is a Food and Drug Administration (FDA)-approved third-line therapy for nDO and idiopathic OAB. Although intradetrusor injection of onaBoNT-A 200 U is already approved for nDO treatment, most researchers would like to manage PD and post-stroke patients by using onaBoNT-A 100 U intradetrusor injection to achieve long-term efficacy and reduce adverse effects. However, in contrast to its inclusion in the International Continence Society guidelines for PD treatment, the clinical use of BoNT-A for post-stroke patients is limited to experimental use due to the development of urinary retention in about one-fifth of patients. For treating urethral pseudodyssynergia, half of patients may respond to onaBoNT-A 100 U urethral injection. However, refinement is needed to reduce unwanted urinary incontinence.

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Frontiers in the Clinical Applications of Botulinum Toxin A as Treatment for Neurogenic Lower Urinary Tract Dysfunction

Cited by 13 publications

References 98 publications

Development of an Automatic Interpretation Algorithm for Uroflowmetry Results: Application of Artificial Intelligence

Development of an Automatic Interpretation Algorithm for Uroflowmetry Results: Application of Artificial Intelligence

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury

Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson’s Disease or Post-Stroke

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