title: Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review.
abstract: OBJECTIVE
  This systematic literature review discusses the efficacy and safety of botulinum toxin type A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity (NDO) and urinary incontinence or overactive bladder symptoms of neurogenic origin (NOAB).
  
  
  METHODS
  A MEDLINE and EMBASE search for clinical studies with botulinum toxin A injected into the detrusor of adults with NDO was performed. For several efficacy and safety variables data were extracted by one person and independently quality-controlled by another person. Extracted data were reviewed to propose recommendations for use in clinical practice based on level of evidence and expert opinion.
  
  
  RESULTS
  A total of 18 articles evaluating the efficacy or safety of Botox in patients with NDO and incontinence/NOAB resistant to antimuscarinic therapy, with or without clean intermittent self-catheterisation (CIC), were selected. The amount of Botox injected was mostly 300 U, usually as 30 injections of 10 U/ml in the bladder (excluding the trigone) under cystoscopic guidance and with different types of anaesthesia. Most of the studies reported a significant improvement in clinical (approximately 40-80% of patients became completely dry between CICs) as well as urodynamic (in most studies mean maximum detrusor pressure was reduced to < or =40 cm H(2)O) variables and in the patients' quality of life, without major adverse events.
  
  
  CONCLUSIONS
  Botox injections into the detrusor provide a clinically significant improvement in adults with NDO and incontinence/NOAB refractory to antimuscarinics. It seems to be very well tolerated. However, more adequately powered, well-designed, randomised, controlled studies evaluating the optimal dose, number and location of injections, impact on antimuscarinic regimen and CIC use, duration of effect, and when to perform repeat injections are warranted.
authors.affiliation: Hôpital Sainte Marguerite, Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.forename: Gérard
authors.initials: G
authors.lastname: Amarenco
authors.forename: Marianne
authors.initials: M
authors.lastname: De Seze
authors.forename: Xavier
authors.initials: X
authors.lastname: Gamé
authors.forename: François
authors.initials: F
authors.lastname: Haab
authors.forename: Jacques
authors.initials: J
authors.lastname: Kerdraon
authors.forename: Brigitte
authors.initials: B
authors.lastname: Perrouin-Verbe
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.forename: Christian
authors.initials: C
authors.lastname: Saussine
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Soler
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schurch
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chartier-Kastler
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A