title: Clinical Efficacy and Changes of Urothelial Dysfunction after Repeated Detrusor Botulinum Toxin A Injections in Chronic Spinal Cord-Injured Bladder.
abstract: Chornic spinal cord injury (SCI) will induce bladder urothelium dysfunction. This study investigated the therapeutic effects on urothelial dysfunction after repeated detrusor injections of onabotulinumtoxinA (BoNT-A) in SCI patients with neurogenic detrusor overactivity (NDO). Twenty chronic suprasacral SCI patients with NDO were enrolled. The patients received 300 U BoNT-A injection into the detrusor every six months. The urothelium was assessed by cystoscopic biopsy at baseline and six months after each BoNT-A treatment. Immunofluorescence staining for urothelial dysfunction, including E-cadherin, zonula occludens-1 (ZO-1), tryptase for mast cell activity, and urothelial apoptosis were investigated. The outcome of urothelial dysfunction parameters after BoNT-A injection were compared between baseline and six months after each treatment. Repeated 300 U BoNT-A injections showed a sustained decrease of detrusor pressure compared with baseline. After three repeated BoNT-A detrusor injections, significantly greater distributions of E-cadherin (p = 0.042) and ZO-1 (p = 0.003) expressions, but no significant changes, of urothelial apoptosis and mast cell activation were found after repeated BoNT-A therapy. Urothelial dysfunction, such as adhesive and junction protein concentrations in SCI patients' bladders, recovered after three repeated cycles of BoNT-A treatment. The therapeutic effects sustained. However, urothelial inflammation and apoptosis after SCI were not significantly improved after three repeated BoNT-A injections.
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualian 970, Taiwan. madaux@yahoo.com.tw.
authors.forename: Sheng-Fu
authors.initials: SF
authors.lastname: Chen
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualian 970, Taiwan. cha615@tzuchi.com.tw.
authors.forename: Chia-Hwei
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualian 970, Taiwan. ck@tzuchi.com.tw.
authors.forename: Hann-Chorng
authors.initials: HC
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D015703:Antigens, CD; D017209:Apoptosis / Q000187:drug effects; D019274:Botulinum Toxins, Type A / Q000494:pharmacology / Q000627:therapeutic use*; D015820:Cadherins / Q000378:metabolism; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth; D009465:Neuromuscular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D014563:Urodynamics; D019459:Urothelium / Q000187:drug effects / Q000378:metabolism / Q000502:physiology; D062826:Zonula Occludens-1 Protein / Q000378:metabolism
chemical_list: D015703:Antigens, CD; C513384:CDH1 protein, human; D015820:Cadherins; D009465:Neuromuscular Agents; C569042:TJP1 protein, human; D062826:Zonula Occludens-1 Protein; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin A; spinal cord injury; urothelial dysfunction