Botulinum toxin A for treatment of neurogenic detrusor overactivity and incontinence in patients with spinal cord lesions

Objective: To evaluate the efficacy of intravesical botulinum toxin A (BTA) in the treatment of severe neurogenic detrusor overactivity (NDO) with incontinence in patients with spinal cord lesions (SCLs). Material and Methods: Fifteen SCL patients suffering from NDO and incontinence were included in the study. The volume of urine leakage during episodes of incontinence was quantified, and filling cystometry was performed before and after BTA treatment. During BTA treatment, a total of 300 IU of BTA was injected cystoscopically into the detrusor muscle, excluding the trigone region. Antibiotic prophylaxis was given. Results: Thirteen of 15 patients (87%) reported that they were fully continent after treatment and the volume of leakage in the two incontinent patients was significantly reduced. Anticholinergic medication was stopped in all patients after BTA treatment. Cystometry showed a marked reduction in pressures after treatment in all patients, with the maximum detrusor pressure during filling being significantly reduced (p < 0.0005) and the maximum volume at a detrusor pressure of <40 cmH(2)O being significantly increased (p < 0.0005) in all patients. The maximum bladder capacity was increased, although not significantly. The period during which the patients remained continent following treatment ranged from 4 to 12 months (median 7 months). With the exception of slight haematuria, which resolved spontaneously, no side-effects were observed, and no cases of autonomic hyperreflexia were seen during treatment. Conclusion: BTA proved to be a highly effective treatment modality for NDO and incontinence in SCL patients. Treatment was easy to perform and the duration of effect was acceptable. Furthermore, BTA treatment was associated with virtually no side-effects.