This systematic literature review discusses the efficacy and safety of botulinum toxin type A (Botox®) intradetrusor injections in adults with neurogenic detrusor overactivity (NDO) and urinary incontinence or overactive bladder symptoms of neurogenic origin (NOAB).
A MEDLINE and EMBASE search for clinical studies with botulinum toxin A injected into the detrusor of adults with NDO was performed. For several efficacy and safety variables data were extracted by one person and independently quality-controlled by another person. Extracted data were reviewed to propose recommendations for use in clinical practice based on level of evidence and expert opinion.
A total of 18 articles evaluating the efficacy or safety of Botox in patients with NDO and incontinence/NOAB resistant to antimuscarinic therapy, with or without clean intermittent self-catheterisation (CIC), were selected. The amount of Botox injected was mostly 300 U, usually as 30 injections of 10 U/ml in the bladder (excluding the trigone) under cystoscopic guidance and with different types of anaesthesia. Most of the studies reported a significant improvement in clinical (approximately 40–80% of patients became completely dry between CICs) as well as urodynamic (in most studies mean maximum detrusor pressure was reduced to ≤40 cm H2O) variables and in the patients’ quality of life, without major adverse events.
Botox injections into the detrusor provide a clinically significant improvement in adults with NDO and incontinence/NOAB refractory to antimuscarinics. It seems to be very well tolerated. However, more adequately powered, well-designed, randomised, controlled studies evaluating the optimal dose, number and location of injections, impact on antimuscarinic regimen and CIC use, duration of effect, and when to perform repeat injections are warranted.
Keywords: Botulinum toxin type A, Cholinergic antagonist, Overactive bladder, Urinary bladder, Neurogenic, Urinary incontinence, Urodynamics.
a Hôpital Sainte Marguerite, Marseille, France
b Hôpital Raymond Poincaré, Garches, France
c Hôpital Rothschild, Paris, France
d Hôpital Pellegrin, Bordeaux, France
e Hôpital Rangueil, Toulouse, France
f Hôpital Tenon, Paris, France
g Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de Kerpape, Ploemeur, France
h Hôpital St Jacques, Nantes, France
i Hôpital Henry Gabrielle, Saint Genis Laval, France
j Hôpital Civil, Strasbourg, France
k Centre Bouffard Vercelli, Cerbère, France
l Hôpital Universitaire Balgrist, Zurich, Switzerland
m Hôpital Pitié-Salpêtrière, Paris, France
Corresponding author. Department of Urology, Medical School Pierre et Marie Curie, University Paris VI, Hôpital Pitié-Salpêtrière, 83, Boulevard de L’Hôpital, 75013 Paris, France. Tel. +33 1421 77 129; Fax: +33 1421 77 160.
© 2007 European Association of Urology, Published by Elsevier B.V.