Intramuscular Detrusor Injection of Botulinum Toxin Type A as a Therapeutic Option for Bladder Preservation in Patients With Severe Neurogenic Detrusor Overactivity
David Gordon, M.D., Todd Lehrfeld, M.D., Joseph Serio, R.N., Mary Beck-Grimm, PA-C, Tao Nguyen, M.D..
Chesapeake Urology Associates, Owings Mills, MD, USA.
Aims: Botulinum toxin type A (BoNT-A) has shown promise in treating neurogenic detrusor overactivity (NDO), but studies conducted to date have not been in patients with severe urge urinary incontinence (UUI). This study examines our experience using BoNT-A in such patients.
Methods: This was a retrospective review of patients with UUI secondary to NDO who were treated with BoNT-A. Patients had almost constant urine leakage. BoNT-A 200U was injected transurethrally into 30 detrusor sites. Patients could receive repeated BoNT-A injections at the treating physician’s discretion. Follow-up was 3-weekly for the first 6 weeks, then 6-weekly for up to 18 months. Urodynamic examination was conducted at follow-up visits in patients who did not experience clinical improvement.
Results: A total of 21 patients (9 men, 12 women) with proven NDO and UUI were included in the study. Patients received one (n=6), two (n=5), three (n=5), four (n=3) or five (n=2) treatments with BoNT-A (interval between injections approximately 1-17 months) and were followed-up for ≥12 months. At the end of follow-up, MCC had improved from baseline in all patients (mean change +xxx mL; p<0.xx). Treatment was considered successful in 17 patients who achieved MCC of >200 mL; these patients could be managed by suprapubic catheter placement; timed voiding + clean intermitted catheterization (CIC) or medications; or sling + CIC or suprapubic catheterization.
Conclusions: In patients with endstage NDO, intradetrusor injection of BoNT-A improves urodynamic parameters and circumvents the need for major surgical urinary diversion.