title: Botulinum toxin type A injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions.
abstract: 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.
authors.affiliation: Department of Rehabilitation Medicine, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand. jklaphaj@mail.med.cmu.ac.th
authors.forename: Jakkrit
authors.initials: J
authors.lastname: Klaphajone
authors.forename: Wasuwat
authors.initials: W
authors.lastname: Kitisomprayoonkul
authors.forename: Supon
authors.initials: S
authors.lastname: Sriplakit
mesh_terms: 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
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A