Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study.
METHODS
This was a multicentre, prospective, randomised study.


OBJECTIVE
To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO).


METHODS
Urology departments of two tertiary hospitals in the Czech Republic.


METHODS
A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment.


RESULTS
In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group.


CONCLUSIONS
Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation.
Department of Urology, University Hospital, Ostrava, Czech Republic. jan.krhut@fnspo.cz
J
J
Krhut
V
V
Samal
D
D
Nemec
P
P
Zvara
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D001743:Urinary Bladder; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D014549:Urinary Incontinence / Q000188:drug therapy; D014563:Urodynamics / Q000502:physiology; D019459:Urothelium; D055815:Young Adult
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A