title: Meta-analysis of botulinum toxin A detrusor injections in the treatment of neurogenic detrusor overactivity after spinal cord injury.
abstract: OBJECTIVE
  To examine the effectiveness of botulinum toxin type A (BTX-A) on neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI).
  
  
  METHODS
  MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to June 2012.
  
  
  METHODS
  Trials examining the use of BTX-A injections into the detrusor wall in the treatment of NDO after SCI were included if (1) ≥ 50% of study sample comprised subjects post-SCI; (2) outcomes of interest were assessed before and after treatment with a single injection of BTX-A; and (3) the sample size was ≥ 3.
  
  
  METHODS
  A standardized mean difference ± SE (95% confidence interval) was calculated for at least 1 of the following outcomes in every study: postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, catheterization frequency, and maximum flow rate. Results from all studies were then pooled using a random-effects model. Treatment effect sizes were interpreted as small, >0.2; moderate, >0.5; or large, >0.8.
  
  
  RESULTS
  Fourteen studies representing data from 734 subjects were included. After BTX-A injection, large treatment effects were observed in postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, and catheterization frequency (P<.01). Rate of incontinence episodes was reduced from 23% to 1.31% after BTX-A treatment. No significant decrease in max flow rate was observed (P=.403).
  
  
  CONCLUSIONS
  Results of the meta-analysis indicate BTX-A is effective in treating NDO after SCI. The use of BTX-A was associated with a decrease in incontinence episodes, catheter use, and bladder pressures.
authors: Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada.
authors: Swati
authors: S
authors: Mehta
authors: Denise
authors: D
authors: Hill
authors: Amanda
authors: A
authors: McIntyre
authors: Norine
authors: N
authors: Foley
authors: Jane
authors: J
authors: Hsieh
authors: Karen
authors: K
authors: Ethans
authors: Robert W
authors: RW
authors: Teasell
authors: Eldon
authors: E
authors: Loh
authors: Blayne
authors: B
authors: Welk
authors: Dalton
authors: D
authors: Wolfe
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D006801:Humans; D007273:Injections, Intramuscular; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: BTX-A; Botulinum toxins; NDO; PRV; QOL; Rehabilitation; SCI; Spinal cord injuries; UTI; Urinary bladder; botulinum toxin type A; neurogenic detrusor overactivity; postresidual urine volume; quality of life; spinal cord injury; urinary tract infection