Intradetrusor botulinum toxin injections (300 units) for the treatment of poorly compliant bladders in patients with adult neurogenic lower urinary tract dysfunction

Abstract

Aims: To evaluate the therapeutic effects of intradetrusor onabotulinum toxin A (BTX) injections in patients with adult neurogenic lower urinary tract dysfunction (ANLUTD) and medically refractory poorly compliant bladders. Methods: We retrospectively evaluated patients with urodynamic studies (UDS)-proven, medically refractory impaired bladder compliance (≤20 mL/cm H 2 O) secondary to spinal myelopathy treated with 300 units of BTX cystoscopically injected into the detrusor muscle. Objective improvement in compliance was defined as an increase ≥5 mL/cm H 2 O on repeat urodynamics. Characteristics were compared between patients who demonstrated symptomatic and objective improvement following treatment versus those without. Results: Seventy-one individuals were included in the final analysis. Mean patient age was 37.2 years (range: 18-78) and ANLUTD duration was 14.5 years (range: 1-34). Average pre-injection bladder compliance was 9.2 mL/cm H 2 O (range: 3.0-16.7). After treatment with BTX, 37 of 71 (52%) patients reported subjective reductions in lower urinary tract symptoms. Repeat UDS demonstrated objective bladder compliance improvements in 22 of 71 (31%). Individuals with shorter time intervals since neurologic injury responded better to BTX than those with longer durations (P = .032). Conclusion: BTX injections significantly improved symptoms and bladder compliance in 31% of ANLUTD patients with medical refractory poorly compliant bladders.

Deterioration of bladder compliance after botulinum toxin A injection and discontinuation of medication for overactive bladder

“…BTX‐A injections improve bladder compliance in some patients with neurogenic low compliance bladders who are refractory to oral medications 4–6 . However, it seems that the effectiveness of this method is lower in both adults and children with spinal disorders and low compliance bladder 4–6 . O'Connor et al .…”

“…O'Connor et al . evaluated patients with refractory impaired bladder compliance secondary to spinal myelopathy treated with 300 units of BTX‐A injection 4 . Bladder compliance was improved only in 22 of 71 (31%) patients, leaving the remaining patients (69%) as non‐responders.…”

“…BTX-A injections improve bladder compliance in some patients with neurogenic low compliance bladders who are refractory to oral medications. [4][5][6] However, it seems that the effectiveness of this method is lower in both adults and children with spinal disorders and low compliance bladder. [4][5][6] O'Connor et al evaluated patients with refractory impaired bladder compliance secondary to spinal myelopathy treated with 300 units of BTX-A injection.…”

“…[4][5][6] However, it seems that the effectiveness of this method is lower in both adults and children with spinal disorders and low compliance bladder. [4][5][6] O'Connor et al evaluated patients with refractory impaired bladder compliance secondary to spinal myelopathy treated with 300 units of BTX-A injection. 4 Bladder compliance was improved only in 22 of 71 (31%) patients, leaving the remaining patients (69%) as non-responders.…”

Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do?

“…In patients with NDO, repeat Botox injections allow sustained improvements in UUI, with an acceptable rate of adverse events [ 55 ]. The efficacy of repeat detrusor Botox injections included significant improvement in urinary symptoms and bladder compliance in 52% of patients, and 31% of patients had an objective improvement in bladder compliance [ 56 ].…”