Botulinum toxin-type A in the treatment of drug-resistant neurogenic detrusor overactivity secondary to traumatic spinal cord injury

In this section, many different issues are written about by authors from the UK, France, the Netherlands, the USA and Denmark, respectively. Topics covered are botulinum toxin in drug-resistant neurogenic detrusor overactivity in spinal cord injury, dutasteride and BPH, the effect of childbirth on bothersome LUTS, female urethral strictures, and a new bulking agent in treating female stress urinary incontinence.

OBJECTIVES

To assess, in a prospective study, whether botulinum toxin-type A (BTX-A) injected into the detrusor muscle, can be used as a day-case treatment for drug-resistant neurogenic detrusor overactivity (NDO) in patients with spinal cord injury (SCI).

PATIENTS AND METHODS

BTX-A (Dysport, Ipsen, Luxembourg; 1000 units) was injected cystoscopically into the detrusor muscle of 37 patients with drug-resistant NDO and SCI, as a day-case procedure. The maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), NDO, continence, and anticholinergic requirement were used as outcome variables. The International Consultation on Incontinence questionnaire (ICIQ) was used to assess the patient's quality of life before and after the BTX-A injection.

RESULTS

The mean follow-up was 7 months. The MCC increased from a mean of 259 to 522 mL, and the MDP decreased from a mean of 54 to 24 cmH₂O. Incontinence and NDO were abolished in 82% and 76% patients, respectively. In all, 86% of the patients were able to stop or reduce anticholinergics, with a similar proportion of patients scoring favourably on the ICIQ. The mean duration of improvement was 9 months.

CONCLUSIONS

Injection with BTX-A is an effective day-case treatment that bridges the gap between oral and invasive surgical treatment of drug-resistant NDO in patients with SCI.