Articles

Review – Neuro-urology

Botulinum Toxin A (Botox®) Intradetrusor Injections in Adults with Neurogenic Detrusor Overactivity/Neurogenic Overactive Bladder: A Systematic Literature Review

By: Gilles Karsentya, Pierre Denysb, Gérard Amarencoc, Marianne De Sezed, Xavier Gamée, François Haabf, Jacques Kerdraong, Brigitte Perrouin-Verbeh, Alain Ruffioni, Christian Saussinej, Jean-Marc Solerk, Brigitte Schurchl and Emmanuel Chartier-Kastlerm lowast

European Urology, Volume 53 Issue 1, February 2008, Pages 275-287

Published online: 01 February 2008

Keywords: Botulinum toxin type A, Cholinergic antagonist, Overactive bladder, Urinary bladder, Neurogenic, Urinary incontinence, Urodynamics

Abstract Full Text Full Text PDF (539 KB)

Abstract

Objectives

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).

Methods

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.

Results

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 10U/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 ≤40cm H2O) variables and in the patients’ quality of life, without major adverse events.

Conclusions

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.

Take Home Message

This systematic literature review discusses the efficacy and safety of Botox® intradetrusor injections in adults with neurogenic detrusor overactivity. Treatment with Botox is clinically effective in improving urodynamic parameters as well as urinary incontinence and is well tolerated.

Keywords: Botulinum toxin type A, Cholinergic antagonist, Overactive bladder, Urinary bladder, Neurogenic, Urinary incontinence, Urodynamics.

Footnotes

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

lowast 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.

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