Efficacy and impact of botulinum toxin A on quality of life in patients with neurogenic detrusor overactivity: A randomized, placebo-controlled, double-blind study

Objective. To evaluate the effect of a single injection of 500 U of botulinum toxin A (BTX- A; on use of oral rescue medication, bladder compliance, continence and quality of life in a randomized, placebo-controlled, doubleblind study in patients with incontinence due to neurogenic detrusor overactivity. As this group of patients often have severe symptoms, oral tolterodine was allowed as rescue medication and the amount of tolterodine consumed was our primary endpoint. Material and methods. A total of 31 patients with urinary leakage due to spinal cord injury, myelomeningocele, trauma at birth, multiple sclerosis and myelitis of another cause were randomized to intravesical injections of either 500 U of BTX- A or placebo. Intake of tolterodine and episodes of urinary leakage were registered. Cystometry was performed after 6, 12 and 26 weeks and quality of life was assessed. Results. Patients in the BTX-A group had a significantly lower intake of tolterodine throughout the study compared to those in the placebo group (p = 0.003). Cystometric capacity was significantly higher at 6 (p<0.001) and 12 weeks (p = 0.026) and maximum detrusor pressure and frequency of urinary leakage were significantly (p<0.01) lower during follow-up in the BTX-A group compared to the placebo group. In addition, many quality-of-life parameters were significantly improved in the BTX-A group compared to the placebo group. Conclusions. Intravesical injection of 500 U of BTX-A in patients with neurogenic detrusor instability was shown to be an effective treatment which reduced use of oral medication, high detrusor pressure and frequency of urinary leakage during the overall study period of 26 weeks. Quality of life was also significantly improved.