title: Submucosal administration of onabotulinumtoxinA in the treatment of neurogenic detrusor overactivity: pilot single-centre experience and comparison with standard injection into the detrusor.
abstract: BACKGROUND
  Apart from the standard intramural administration of botulinum neurotoxin A (BoNT/A) to the detrusor, intense research is taking place into new means of administration in view of the complex mechanism of action of BoNT/A.
  
  
  METHODS
  An open, randomised, prospective study was performed on a total of 23 patients with neurogenic detrusor overactivity. Following randomisation, patients were treated with 300 U of onabotulinumtoxinA (onaBoNT/A) in either the submucosa or the detrusor. Urodynamic examinations were carried out, and a bladder diary was kept both prior to and 12 weeks after the treatment. All patients stopped taking anticholinergics 1 week prior to the treatment.
  
  
  RESULTS
  In both the submucosa and detrusor groups, we recorded a significant improvement in the monitored urodynamic parameters and significant decreases in the frequency of urinary incontinence episodes following the treatment. A comparison of the two groups showed no significant difference between the two forms of application, with the exception of voided volume (p = 0.007).
  
  
  CONCLUSIONS
  A comparison of the two administration methods did not show any significant difference between onaBoNT/A administration to the submucosa and to the detrusor. Thus, the submucosal injection of onaBoNT/A represents an equally effective approach for its administration to patients.
authors.affiliation: Department of Urology, Regional Hospital Liberec, Liberec, Czech Republic.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Šámal
authors.forename: Jan
authors.initials: J
authors.lastname: Mečl
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Šrám
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000187:drug effects; D009130:Muscle, Smooth / Q000187:drug effects; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000517:prevention & control; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000628:therapy; D014563:Urodynamics; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A