Efficacy of botulinum-A toxin in adults with neurogenic overactive bladder: initial results.
OBJECTIVE
To study the effects of intradetrusor botulinum-A toxin (BTA) (BOTOX) injections in adult patients with detrusor overactivity who failed to respond to anticholinergic medications or developed intolerable side-effects.


METHODS
Ten patients (average age 41 years, range 19-76 years) with neurogenic bladder and detrusor overactivity who were using clean intermittent catheterization 4 to 7 times a day with anticholinergic therapy were included in our study. Their history, physical examination, abdominal ultrasound, urine analysis, serum creatinine and electrolytes, as well as multichannel urodynamic evaluation were documented before administration of BTA injections. Anticholinergic medication was stopped at the time of injection. Three hundred to 400 U of BTA were injected into 30 to 40 different sites in the detrusor muscle under cystoscopic guidance. Clinical assessment and urodynamic testing were repeated 3 months after injection.


RESULTS
Five patients were tetraplegic and five were paraplegic at the thoracic or lumbar level. Three patients had incontinence episodes between catheterizations before treatment, and only one patient continued to have incontinence episodes between catheterizations after treatment. Reflex volume increased by 63.08% from 180 +/- 44.99 ml to 293.7 +/- 208.42 ml (p < 0.02). Maximal bladder capacity was augmented by 73.63% from 290 +/- 131.64 ml to 518.20 +/- 273.35 ml (p < 0.03). Maximal detrusor pressure decreased by 15.52% from 69.60 +/- 39.19 cmH(2)O to 58.80 +/- 33.95 cmH(2)O (p < 0.2). No patients complained of side effects.


CONCLUSIONS
BTA appears to be an effective and safe therapeutic option for overactive bladder in patients with spinal cord injury failing anticholinergic therapy and delays more invasive treatments. These initial results confirm European literature reports.
Hajebrahimi
S
S
Department of Urology, Jewish General Hospital, McGill University, and Readaptation Institute of Montreal, Montreal, Quebec H3T 1E2, Canada.
Altaweel
W
W
Cadoret
J
J
Cohen
E
E
Corcos
J
J
D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000150:complications; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A