More Than 15 Years of Experience with Intradetrusor OnabotulinumtoxinA Injections for Treating Refractory Neurogenic Detrusor Overactivity: Lessons to Be Learned

Is repeat Botulinum Toxin A injection valuable for neurogenic detrusor overactivity—A systematic review and meta‐analysis

“…Eighteen studies involving 1533 patients were included in the review and their characteristics are shown in Table 1. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] The level of evidence of the included studies ranged from 3 to 4. Ten studies were retrospective case series, [12][13][14][15][16][17][18][19]22,27 seven studies were prospective cohort studies 11,20,21,23,24,26,28 and the remaining article was a mixed study comprising both retrospective and prospective components.…”

“…Ten studies were retrospective case series, [12][13][14][15][16][17][18][19]22,27 seven studies were prospective cohort studies 11,20,21,23,24,26,28 and the remaining article was a mixed study comprising both retrospective and prospective components. 25 Thirteen studies used Botox, 12,15,[17][18][19][20][21][23][24][25][26][27][28] four studies used Dysport, 13,14,16,22 and one study used both Botox and Dysport. 11 Botox was administered at doses of 200 or 300 U, and Dysport was administered at doses ranging from 500 to 1000 U.…”

“…13 The remaining studies did not include information regarding anticholinergic use during treatment. 12,18,21,22,25,26,28 The number of patients receiving repeat BTX-A injections varies throughout the literature, as it ranges from 20 to 388. The number of patients who received repeat injections and the percentage of patients who continued receiving injections after each injection are shown in Table 2.…”

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

“…38,39 Furthermore, in the longest follow-up study of the use of onabotulinumtoxinA (15 years), the overall discontinuation rate amongst all neurogenic patients (SCI, MS, MMC) was 40%, and only 14% of MS patients continued with the treatment. 40 …”

Intravesical vanilloids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: A systematic review and meta‐analysis. A report from the Neuro‐Urology Promotion Committee of the International Continence Society (ICS)

“…Vanilloids are contraindicated in case of ureteral reflux, bladder mucosa lesions, coagulation impairment, pregnancy, and breastfeeding. 29 discontinue treatment over time due to a lack of clinical and/or urodynamic efficacy or switch to another treatment, 39 so that alternative treatment options are urgently needed. Indeed, vanilloids might become a promising therapeutic alternative but not in its current form because of the unfavorable safety profile.…”