[Efficacy of botulinum toxin A for the treatment of detrusor hyperreflexia].
OBJECTIVE
To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bladder hyperreflexia.


METHODS
The international medical literature was reviewed from the Medline and Pubmed database.


CONCLUSIONS
The usual first line treatment of detrusor hyperreflexia is parasympathicolytic drugs and self cathterization. In case of lack of efficacy or severe side effects, a surgical procedure (enterocystoplasty) can be performed. 300 units of Botox injected into the detrusor permit a significant increase of bladder capacity and a significant decrease of maximal detrusor pressure for at last 6 months. But we did not find any double blind controlled studies in this indication and no fundamental studies focused on the mechanism of action of botulinum toxin on the bladder muscle. It is now impossible to conclude on the long term efficacy and toxicity.


CONCLUSIONS
Botulinum toxin injected into the detrusor muscle seems to be an efficient treatment of bladder hyperreflexia for 6 months in patients resistant to parasympathicolytic drugs. Long term efficacy and mechanism of action is actually not known.
Denys
P
P
Service de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, faculté de médecine Paris Ile-de-France ouest, 104, boulevard Raymond-Poincaré, 92380 Garches, France. pierre.denys@rpc.ap-hop-paris.fr
Even-Schneider
A
A
Thiry Escudie
I
I
Ben Smail
D
D
Ayoub
N
N
Chartier-Kastler
E
E
D020211:Autonomic Dysreflexia / Q000188:drug therapy; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D009122:Muscle Hypertonia / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology; D014563:Urodynamics
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A