Therapeutic effects of detrusor botulinum toxin A injection on neurogenic detrusor overactivity in patients with different levels of spinal cord injury and types of detrusor sphincter dyssynergia

Study design: The study was designed as a single-arm clinical trial. Objectives: To investigate the therapeutic effects of detrusor botulinum toxin A (BoNT-A) treatment in patients with different levels of spinal cord injury (SCI) and types of detrusor sphincter dyssynergia (DSD). Setting: Patients with chronic suprasacral SCI and neurogenic detrusor overactivity (NDO) were treated with 200-U BoNT-A detrusor injection in a tertiary university hospital in Taiwan. Methods: Outcome assessment of urodynamic parameters and therapeutic satisfaction were performed at 3 and 6 months among patients with different demographics, SCI levels and types of DSD. The treatment outcomes were assessed by changes in Urogenital Distress Inventory 6-item short form (UDI-6), quality of life (QoL) index and detrusor pressure at maximum flow rate (Pdet.Qmax). Results: A total of 38 patients with a mean age of 40.1 +/- 12.4 years and median duration of SCI of 10.3 years were enrolled. Satisfactory response was reported in 23 (60%) patients. Significant improvements in the UDI-6 and QoL were reported and significant increases of cystometric bladder capacity and post-void residual were noted in overall patients after treatment. Patients with different clinical demographics and urodynamic parameters had similar treatment outcomes and UDI-6 scores. In 11 patients receiving repeat injections of 300U of BoNT-A after failure of a previous 200 U injection, the treatment outcomes were not significantly different, except that the PdetQmax at 6 months were higher in the group that received 200U of BoNT-A. Conclusion: Patients with different SCI levels or DSD types had similar treatment outcomes after detrusor 200U BoNT-A injections for NDO. Spinal Cord (2011) 49, 659-664; doi: 10.1038/sc.2010.179; published online 18 January 2011