Treatment of neurogenic detrusor overactivity with botulinum toxin A: the first seven years.
BACKGROUND
This retrospective study describes the results of botulinum toxin A detrusor injections following a fixed protocol in 216 patients with untreatable neurogenic detrusor overactivity and incontinence. A comparison is made between the two preparations currently available, and the efficacy of multiple treatments is studied.


METHODS
Botox 300 MU (mouse units) or Dysport 750 MU were injected into the detrusor wall in 365 sessions in 216 patients. The average age of the 144 men and 72 women was 32.3 years. Patients were investigated before treatment and at 6 weeks and 6 months after treatment. Maximal detrusor pressure, detrusor compliance, reflex volume and cystometric capacity were recorded. Use of anticholinergics and patient satisfaction were ascertained from questionnaires. Appropriate statistics were applied.


RESULTS
All urodynamic parameters improved. The use of anticholinergics decreased substantially. No differences were noted between the two preparations. The incontinence situation improved markedly. The effect of the treatment was noted after about 2 weeks and lasted for about 9 months.


CONCLUSIONS
Botulinum toxin A treatment in neurogenic detrusor overactivity patients is effective, long-lasting and repeatable. The treatment is minimally invasive and might be considered as an alternative to high-dosage anticholinergic medication.
Stoehrer
Manfred
M
Department of Urology, Berufsgenossenschaftliche Unfallklinik, Murnau, Germany. manfred@stoehrer.com
Wolff
Andreas
A
Kramer
Guus
G
Steiner
Rainer
R
Lmöchner-Ernst
Dieter
D
Leuth
Dirk
D
Steude
Ute
U
Ruebben
Herbert
H
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A