The Effects of Botulinum-a Toxin on Bladder Function and Histology in Spinal Cord Injured Rats: Is There Any Difference Between Early and Late Application?

Temeltaş, Gökhan; Tıkız, Canan; Dağcı, Taner; Tuğlu, Mehmet İbrahim; Yavaşoğlu, Altuğ

doi:10.1097/01.ju.0000180410.78774.b5

Cited by 24 publications

(26 citation statements)

References 12 publications

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“…24 At subsequent followup there were preserved bladder compliance, no detrusor overactivity, and improved bowel and erectile function compared with patients with SCI who were untreated. Similarly, animal studies demonstrated that early medication, 25 intradetrusor onabotulinumtoxinA 26 and neuromodulation 27 can modify long-term urinary tract function after SCI. Moreover, registered clinical trials have been done to further evaluate the ability of early intradetrusor onabotulinumtoxinA injections (ClinicalTrials.gov NCT00711087 and NCT01698138) and early sacral neuromodulation (ClinicalTrials.gov NCT03083366) to preserve lower and upper urinary tract function, and prevent the complications associated with NLUTD.…”

Section: Discussionmentioning

confidence: 91%

Detrusor Acontractility after Acute Spinal Cord Injury—Myth or Reality?

et al. 2018

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In contrast to the common notion of an acontractile detrusor during acute spinal cord injury, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after spinal cord injury. Considering that early treatment of neurogenic lower urinary tract dysfunction in patients with acute spinal cord injury might improve the long-term urological outcome, urodynamic investigation should be performed timely to optimize patient tailored therapy.

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Section: Discussionmentioning

confidence: 91%

Detrusor Acontractility after Acute Spinal Cord Injury—Myth or Reality?

et al. 2018

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“…This result is an argument for an earlier proposal of BTX-A injection therapy in refractory NDO due to MS. However, the study on rats from Temeltas did not find any histological difference of the bladder tissue after BTX-A injection either if the injection was (25). Still MS is a progressive disease, and the duration of the disease is associated with new neurological lesions.…”

Section: Discussionmentioning

confidence: 98%

Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients

et al. 2011

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Purpose: Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS. Materials and Methods: Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor). Results: 77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015). Conclusions: Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anticholinergic drugs fail to reduce NDO. Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system. The lesions occur in different time and localization in subcortical areas, brain stem and spinal cord. The disease has varied clinical presentations (1). Bladder and urethra dysfunction are very common. Detrusor overactivity is the most common urodynamic sign. It is observed in 44% (2) to 81% (3) of patients. Detrusor sphincter dyssynergia is associated with overactive detrusor in 93% of cases (2).Detrusor overactivity is often associated with overactive bladder, defined by urgency, possibly associated with urge incontinence, daytime frequency, and nocturia (4). These symptoms significantly alter the quality of life (5). Urological complications including hydronephrosis, vesicoureteral reflux, urosepsis, and urolithiasis (6) occur in 12% of the patients who suffer from neurogenic detrusor overactivity (NDO) and MS (7). The rate NeurourologyInternational Braz J Urol

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“…Temeltas et al8 examined the effects of early and late applications of BoNT‐A on histological bladder changes in spinal cord injured rats. The animals underwent spinal cord transection, which resulted in increased bladder activity (e.g., detrusor hyperreflexia).…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have examined the histopathological effect of BoNT‐A injections in vivo and existing studies have reported conflicting results. Bladders of spinal cord‐injured rats treated with BoNT‐A showed significantly less fibrosis and hyperplasia compared with untreated ones 8. In contrast, there was no change in bladder mast cell counts and leukocyte infiltration after BoNT‐A treatment in a rat model of chemical cystitis 9.…”

Section: Introductionmentioning

confidence: 93%