Treatment of Neurogenic Detrusor Overactivity after Spinal Cord Injury Using Botulinum A Toxin. Comparison of Endoscopic Submucosal and Intramuscular Route of Application

Summary

Treatment of neurogenic detrusor overactivity using botulinum A toxin is currently the approach of choice in patients refractory to antimuscarinic drugs. This study compares the changes of urodynamic parameters with different routes of botulinum A toxin administration – submucosal and intramuscular. The study monitors changes in selected urodynamic parameters and the number of incontinence episodes as well as an improvement in the quality of life.

Material and methods:
Fifteen patients with neurogenic detrusor overactivity after spinal cord injury aged 25 to 46 year were randomized into two groups to receive 300 U of botulinumtoxin (Botox^®) by cystoscopic approach. In group A, the drug submucosaly and it was administered into detrusor in group B. Urodynamic parameters and the quality of life were evaluated before and 12 weeks after the treatment.

Results:
The authors present results obtained from 15 patients. The number of incontinence episodes decreased after the treatment in about 77% of patients in both groups. Maximum cystometric capacity increased from 236.6 ±76.1 ml to 456 ±73.8 ml in the group with submucosal application (p <0.05) and from 242.7 ±96.8 ml to 432.8 ±79.1 ml in the group with the application into detrusor (p <0.05). Maximum detrusor pressure during involuntary contraction decreased (p <0.05).

Conclusion:
Administration of botulinum A toxin within 3 months after treatment increased the maximum cystometric capacity, decreased maximum detrusor pressure during involuntary detrusor contraction and reduced the number of incontinence episodes. These preliminary results suggest that both methods of administration are comparable.

Key words:
botulinum toxin – detrusor overactivity – incontinence – submucosal application