Satisfaction with Detrusor OnabotulinumtoxinA Injections and Conversion to Other Bladder Management in Patients with Chronic Spinal Cord Injury

Abstract

This study investigated the satisfaction with continued detrusor Botox injections for urinary incontinence and conversion to other surgical procedures and bladder management procedures for neurogenic detrusor overactivity (NDO) in patients with chronic spinal cord injury (SCI). A total of 223 patients with chronic SCI underwent detrusor Botox 200U for urodynamically confirmed NDO and urinary incontinence. After initial detrusor Botox injections, patients opted to either continue detrusor Botox injections every six to nine months and on clean intermittent catheterization (CIC), switch to other bladder management procedures, or receive surgical procedures to improve their urinary incontinence, correct emergent complications, or have better voiding conditions without CIC. Urinary incontinence improvement rates and satisfaction with bladder management were assessed and compared between different subgroups, urodynamic parameters, and bladder management procedures. Finally, a total of 154 male and 69 female patients were included, among whom 56 (25.1%), 81 (36.3%), 51 (22.9%), and 35 (15.7%) showed a marked, moderate, mild, and no reduction in urinary incontinence, respectively. However, only 48.4% of the patients continued detrusor Botox injections over the mean follow-up period of seven years. Patients with cervical or thoracic SCI had fair incontinence improvement rates. The presence of high detrusor pressure and higher-grade bladder outlet resistance also predicted a decrease in incontinence. Although more than 50% of the patients switched to other bladder management procedures or received surgical treatment, 69.1% expressed satisfaction with their current status. This large cohort of patients with chronic SCI who received initial detrusor Botox injections revealed that only 48.4% continued with Botox injections. Those who received surgical procedures due to urological complications or demanded change in bladder management could achieve high satisfaction rates.

Outcomes of sequential third‐line therapies in patients with refractory overactive bladder

“…Our study is the first to report the impact of spinal pathology on post-SNM BoNTA. In prior reports of BoNTA in SCI patients, the success rates were 64.2%, 28 compared to 50%-91% in patients with stroke 29,30 and 79.2%-100% in patients with Parkinson's disease. 31,32 A large phase three trial reported similar results in patients with SCI and MS, 21 with the success rate around 75%.…”

Treating Neurogenic Lower Urinary Tract Dysfunction in Chronic Spinal Cord Injury Patients—When Intravesical Botox Injection or Urethral Botox Injection Are Indicated

“…BoNT-A was initially introduced in urology for treating patients with neurogenic lower urinary tract dysfunction (NLUTD) due to chronic SCI [13,14]. Detrusor BoNT-A injection reduces the incidence of NDO and lowers intravesical pressure, which improves urinary incontinence [15][16][17]. Subsequent studies proved the efficacy of BoNT-A on autonomic dysreflexia (AD) in patients with high-level SCI, in addition to treating NDO and urinary incontinence in pediatric patients with myelomeningocele or other NLUTDs [6].…”

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

“…The most common cause of discontinuation is treatment failure (43.7%). In a long-term follow-up study of the satisfaction rate of patients with SCI and NDO who received detrusor Botox injections, only 48.4% of patients continued Botox injections over 7 years [ 61 ]. The presence of high detrusor pressure and higher-grade bladder outlet resistance are predictive of a decrease in incontinence.…”