Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: clinical and urodynamic results.
BACKGROUND
Most reports in the literature on botulinum toxin A (BoNTA) therapy for neurogenic detrusor overactivity (NDO) are based on the results of a single injection. Because most patients may require retreatment, the efficacy and safety of multiple injections must be addressed clearly.


OBJECTIVE
To investigate the effectiveness and safety of BoNTA intradetrusorial injections in a group of spinal cord-injured (SCI) patients with refractory detrusor overactivity (DO).


METHODS
Seventeen SCI patients were prospectively included in the study and followed up to 6 yr.


METHODS
All patients received repeat intradetrusorial injections of BoNTA 300 units (Botox, Allergan, Irvine, CA) under cystoscopic control on an inpatient basis.


METHODS
The preliminary assessment included voiding diary, urodynamics, kidney and bladder ultrasound, and cystourethrography. Patients also completed a standardised quality-of-life (QoL) questionnaire. Clinical evaluation, urodynamics, urinary tract imaging, and QoL assessment were repeated every year throughout the follow-up.


CONCLUSIONS
Before treatment, all patients complained of urinary incontinence and had DO. Bilateral and monolateral renal pelvis dilatation were detected in six and five patients, respectively, and a monolateral and third-grade vesicoureteral reflux was observed in three. At 6-yr follow-up, a significant decrease in the frequency of daily incontinence episodes (p<0.01), a significant increase in first uninhibited detrusor contraction and in maximum bladder capacity (p<0.001 for both), and a significant decrease in maximum pressure of these contractions (p<0.01) were observed. Fifteen patients (88.2%) were completely continent. Renal pelvis dilatation and vesicoureteral reflux resolved in all cases, and the QoL index significantly increased. Limitations of the study are related to the small number of included patients.


CONCLUSIONS
In SCI patients with refractory NDO who do not want or are unfit for invasive reconstructive surgery, BoNTA intravesical treatment represents a valid alternative to control DO and urinary incontinence and to preserve upper urinary tract function over a long-term follow-up.
Giannantoni
Antonella
A
Department of Urology and Andrology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy. agianton@libero.it
Mearini
Ettore
E
Del Zingaro
Michele
M
Porena
Massimo
M
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A