Botulinum toxin type A injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions.
OBJECTIVE
To evaluate botulinum toxin type A (BTX-A) for treating neurogenic detrusor overactivity in patients with spinal cord lesions, including those with abnormally low bladder compliance.


METHODS
Nonrandomized, before-after trial (9-mo follow-up).


METHODS
Hospitalized care.


METHODS
Ten patients with high detrusor contraction pressure and/or poor response to oxyphencyclimine with incontinence selected as a consecutive sample.


METHODS
BTX-A (Botox; 300U) was injected into the detrusor muscle.


METHODS
Urinary continence, functional bladder capacity, bladder compliance, detrusor contraction pressure, and volume at first reflex voiding. Measurements were taken before and 6, 16, and 36 weeks posttreatment.


RESULTS
Six weeks after treatment, complete continence was restored in 7 patients without oxyphencyclimine. Mean functional bladder capacity (P=.008), compliance (P=.012), and reflex volume (P=.045) significantly increased, whereas maximal detrusor contraction pressure significantly decreased (P<.001). Urodynamic variables remained significantly improved at 16 weeks, but values were returning toward baseline levels by 36 weeks. The procedure was generally uneventful, without any serious side effects.


CONCLUSIONS
BTX-A injections are an effective, well-tolerated treatment for neurogenic detrusor overactivity in patients with spinal cord lesions, even in patients with abnormally low bladder compliance. Patients may require repeat injections after 16 weeks to remain continent.
Klaphajone
Jakkrit
J
Department of Rehabilitation Medicine, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand. jklaphaj@mail.med.cmu.ac.th
Kitisomprayoonkul
Wasuwat
W
Sriplakit
Supon
S
D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000150:complications*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A