Intradetrusor botulinum toxin injections (300 units) for the treatment of poorly compliant bladders in patients with adult neurogenic lower urinary tract dysfunction

• Published in: Neurourology and urodynamics Vol. 39; no. 8; pp. 2322 - 2328
• Main Authors: O'Connor, R. Corey, Johnson, Dane P., Guralnick, Michael L.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2020
• Subjects: Adolescent; Adult; Aged; Bladder; Botulinum toxin; Botulinum toxin type A; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; Central nervous system diseases; Female; Humans; impaired compliance; Injections, Intramuscular; Male; Middle Aged; neurogenic; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - therapeutic use; onabotulinum toxin; Patient Compliance; Patients; Retrospective Studies; Spinal cord; treatment; Treatment Outcome; Urinary Bladder, Neurogenic - drug therapy; Urinary Bladder, Neurogenic - physiopathology; Urinary tract; Urodynamics; Urogenital system; Young Adult; treatment; onabotulinum toxin; impaired compliance; neurogenic; bladder
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.24490

Aims To evaluate the therapeutic effects of intradetrusor onabotulinum toxin A (BTX) injections in patients with adult neurogenic lower urinary tract dysfunction (ANLUTD) and medically refractory poorly compliant bladders. Methods We retrospectively evaluated patients with urodynamic studies (UDS)‐proven, medically refractory impaired bladder compliance (≤20 mL/cm H2O) secondary to spinal myelopathy treated with 300 units of BTX cystoscopically injected into the detrusor muscle. Objective improvement in compliance was defined as an increase ≥5 mL/cm H2O on repeat urodynamics. Characteristics were compared between patients who demonstrated symptomatic and objective improvement following treatment versus those without. Results Seventy‐one individuals were included in the final analysis. Mean patient age was 37.2 years (range: 18‐78) and ANLUTD duration was 14.5 years (range: 1‐34). Average pre‐injection bladder compliance was 9.2 mL/cm H2O (range: 3.0‐16.7). After treatment with BTX, 37 of 71 (52%) patients reported subjective reductions in lower urinary tract symptoms. Repeat UDS demonstrated objective bladder compliance improvements in 22 of 71 (31%). Individuals with shorter time intervals since neurologic injury responded better to BTX than those with longer durations (P = .032). Conclusion BTX injections significantly improved symptoms and bladder compliance in 31% of ANLUTD patients with medical refractory poorly compliant bladders.