BoNT-A Injection for Spinal Cord Injury: History
View Latest Version
Please note this is an old version of this entry, which may differ significantly from the current revision.
Contributor:
Po-Cheng Chen
,
Kau-Han Lee
,
Wei-Chia Lee
,
Ting-Chun Yeh
,
Yuh-Chen Kuo
,
Bing-Juin Chiang
,
Chun-Hou Liao
,
En Meng
,
Yao-Lin Kao
,
Yung-Chin Lee
,
Hann-Chorng Kuo

Lower urinary tract symptoms (LUTS), such as urgency, urinary incontinence, and/or difficulty voiding, hamper the quality of life (QoL) of patients with spinal cord injury (SCI). If not managed adequately, urological complications, such as urinary tract infection or renal function deterioration, may further deteriorate the patient’s QoL. Botulinum toxin A (BoNT-A) injection within the detrusor muscle or urethral sphincter yields satisfactory therapeutic effects for treating urinary incontinence or facilitating efficient voiding.

  • spinal cord injury
  • botulinum toxins
  • lower urinary tract symptoms

1. BoNT-A Detrusor Injection for Neurogenic Detrusor Overactivity and Urinary Incontinence in Chronic SCI Patients

BoNT-A was initially introduced in urology for treating patients with neurogenic lower urinary tract dysfunction (NLUTD) due to chronic SCI [1][2]. Detrusor BoNT-A injection reduces the incidence of NDO and lowers intravesical pressure, which improves urinary incontinence [3][4][5]. Subsequent studies proved the efficacy of BoNT-A on autonomic dysreflexia (AD) in patients with high-level SCI, in addition to treating NDO and urinary incontinence in pediatric patients with myelomeningocele or other NLUTDs [6].
The U.S. Food and Drug Administration and several European countries approved a 200 U BoNT-A detrusor injection as the standard treatment dose for urinary incontinence caused by NDO in SCI patients [7][8][9]; however, preliminary studies used 300 U to demonstrate its therapeutic effect of increasing maximal bladder capacity and compliance and decreasing reflux volume [10][11][12][13]. Compared with placebo, detrusor BoNT-A injection was effective in reducing NDO caused by SCI or multiple sclerosis [14]. Eventually, researchers compared the therapeutic efficacy of the 200 U and 300 U dosages and found that the former achieves comparable effects with possibly fewer adverse events (AEs), leading to the adoption of the 200 U dose by urologists [9]. Furthermore, repeat BoNT-A injections were found to have similar efficacy to the first one [15]. A pooled data analysis by Mangera et al. revealed detrusor BoNT-A injection in SCI patients could facilitate a decrease in the daily incontinence episodes (63%), the frequency of clean intermittent catheterization (CIC) (18%), and maximal detrusor pressure (42%) as well as an increase in the cystometric bladder capacity (68%) and reflux volume (61%) [6][16]. Detrusor BoNT-A injection can also significantly improve health-related quality of life (QoL) indexes [6][17] and decrease the rate of symptomatic urinary tract infection (UTI) in SCI patients [6][18]. The detrusor BoNT-A injection-induced improvement in bladder compliance and urinary continence can persist for up to nine months [4][19], and repeated injections can sustain improvement in continence and QoL [20].
However, symptom evaluation alone may not be sufficient. High intravesical pressure with potential upper urinary tract damage might be missed in some patients with urinary continence after detrusor BoNT-A injection [21]; therefore, a urodynamic examination might be necessary for some patients even with obvious symptomatic relief after detrusor BoNT-A injection [21]. Besides, detrusor BoNT-A injection usually impairs detrusor contractility, leading to a large postvoiding residual volume (PVR) or urinary retention in patients with NDO; hence, patients receiving detrusor BoNT-A injection may require CIC for large PVR and suffer from subsequent UTIs [3].
Several studies compared different BoNT-A injection methods for patients with NLUTD. Krhut et al. compared BoNT-A detrusor injection with submucosal injection in SCI patients with NDO and found no significant difference between the two groups regarding symptomatic improvement, change in urodynamic parameters, efficacy duration, and AEs [22]. Samal et al. also reported concurring findings as the two methods gave similar results in terms of urgency incontinence episodes, number of catheterizations, urodynamic profile, and efficacy duration [23]. Interestingly, Taha et al. compared a trigone-including injection with a trigone-sparing injection in SCI patients with refractory NDO and found that the former group had a significantly lower incontinence rate, higher complete dryness rate, and higher reflux volume [24]. No injection-related vesicoureteral reflux was found in either group. Another randomized control trial compared combined BoNT-A 160 U trigone-sparing and 40 U trigone-including injections with 200 U trigone-sparing BoNT-A injection for NDO in SCI patients [25]. Including the trigone resulted in superior outcomes for QoL, mean urinary incontinence episodes, complete dryness rate, mean voided volume, detrusor pressure, and involuntary detrusor contraction without any vesicoureteral reflux. In another randomized control trial, the effectiveness of combined BoNT-A injection (240 U into the detrusor and 60 U into the trigone) was compared to that of nontrigonal injection (300 U into the detrusor but not the trigone). The trial found that both methods had similar results, but the trigonal injection was found to be safer and more effective than the nontrigonal injection and did not increase the rate of vesicoureteral reflux [26]. The trigone has abundant sensory neural fibers and is highly sensitive to pressure changes, which possibly influences detrusor overactivity; therefore, the denervating effect of the trigone-including injection is more effective in inhibiting involuntary bladder contraction [27].
Treatment efficacy is a crucial factor for deciding whether SCI patients should receive a detrusor BoNT-A injection [28]. Certain pretreatment factors like higher maximum detrusor pressure and lower bladder compliance. Lower maximal cystometric capacity, and poor response after the first injection have been associated with higher treatment failure rates [29][30][31]. NDO patients with initially higher incontinence reduction rates after the first detrusor BoNT-A injection showed better outcomes for incontinence reduction and QoL during the subsequent treatment period [32]. Some NDO patients with poor response to the first dosage also reported gradually higher incontinence reduction after receiving subsequent BoNT-A therapy. Therefore, a second dose of detrusor BoNT-A injection must be given to patients who did not show a good response to the first injection before classifying them as poor responders.

2. Urethral Versus Detrusor BoNT-A Injection in SCI Patients with Urinary Incontinence and Incomplete Bladder Emptying

The presentation of NLUTD depends on the level of SCI—patients with a suprasacral cord injury might develop NDO with or without DSD, and symptoms of frequency, urgency, with or without urgency urinary incontinence, and incomplete voiding [33]. Patients with a sacral lesion might present with a poorly contracting detrusor with incomplete voiding and/or stress-related urinary incontinence associated with a weak sphincter, while a cauda equina lesion may develop detrusor areflexia and incompetent sphincter relaxation [33]. SCI patients commonly have both voiding and storage symptoms [34]; targeting the detrusor for urinary incontinence might worsen bladder emptying ability, whereas targeting the urethral sphincter for voiding dysfunction might aggravate the incontinence. It is a challenge for both the urologist and the patient to balance between being dry and complete bladder emptying.
While a detrusor BoNT-A injection of 200 U or 300 U can improve bladder compliance and restore urinary continence in SCI patients with NDO [4], this treatment usually hampers detrusor contractility. A large PVR or urinary retention might become bothersome, and about 70% of patients require periodic CIC and develop subsequent UTIs [3]. Therefore, a lower dose (200 U over 300 U) of BoNT-A is sufficient to produce similar improvements in urinary incontinence and urgency episodes without altering the spontaneous voiding function that is required [35][36].
Dykstra et al. first reported the use of urethral sphincter BoNT-A injection to improve bladder emptying in SCI patients with DSD [37]. This injection can decrease the mean maximal urethral pressure, duration of DSD, and PVR for three to nine months [1]. Improved voiding and reduced CIC frequency also improve the QoL [38]. However, a urethral sphincter injection would increase the severity of urinary incontinence and urgency or urge urinary incontinence episodes, which might lead to patient dissatisfaction [38][39]. Exacerbated incontinence and urgency episodes might compel the patient to select detrusor BoNT-A injection subsequently [40][41].
The optimal condition for chronic SCI patients is self-voiding without urinary incontinence or severe urgency. In order to achieve this goal of treatment result, concomitant BoNT-A detrusor and urethral sphincter injections might be adopted in patients craving less urinary incontinence and preservation of spontaneous voiding. Huang et al. reported that combined BoNT-A (200 U) detrusor and (100 U) urethral sphincter injections might induce a significant reduction in both detrusor and urethral pressure without increasing PVR, daily CIC frequency, or daily pad use [42]. Another study with the same BoNT-A dosage revealed that a combined injection could lower the detrusor and urethral pressures to improve the patient’s QoL while protecting the upper urinary tract [43].

3. Long-Term Adherence to BoNT-A Injection and Patient Satisfaction

Sex-based differences are an important concern while treating patients with NDO or DSD. Male SCI patients can use an external urine collection device to prevent soiling and usually can do without being totally dry. On the other hand, female SCI patients tend to use a diaper and would rather prefer to be totally dry; if possible, be free of diapers and decrease the need for CIC to a minimum. A small dose of BoNT-A detrusor injection is adequate to increase bladder capacity and decrease urinary incontinence in this condition; Around 24% of patients can void by abdominal tapping (tapping the suprapubic area to induce reflex contraction of the bladder) without requiring CIC [44][45]. A dose–response study compared BoNT-A injections of 200 U, 100 U, and 50 U with placebo injections into the detrusor muscle [1]. The study found that the 50 U dose did not show any significant improvement over the placebo for any of the efficacy parameters. However, the 100 U dose showed some improvement over the placebo, although the observed magnitude of change was generally less favorable compared to that seen with the 200 U dose [1].
Before administering a BoNT-A detrusor injection in SCI patients, the following issues need to be considered:
  • Behavioral modifications should be the primary strategy.
  • BoNT-A injections could be considered in the case of failure of other treatments or intolerable adverse effects of oral medications, such as antimuscarinics or beta-3 agonists.
  • Most patients require CIC after BoNT-A detrusor injection. Patients unable to perform CIC might not be suitable for this treatment.
  • Regular monitoring is essential to check upper urinary tract function and prevent adverse effects and the occurrence of UTIs and large PVR.
  • Repeated injections are required to maintain therapeutic efficacy in SCI patients.
Repeat detrusor injections are required to sustain the therapeutic efficacy of BoNT-A on NDO. An estimated 67% of SCI patients, who received BoNT-A injections for NDO, continued with repeat injections during a five-year follow-up [46]. Of these patients, 90% reported high satisfaction and were willing to consider periodic BoNT-A injections as a long-term treatment option [5][6][46]. Herbert et al. conducted a retrospective chart review for SCI patients with NDO who received BoNT-A therapy and reported a 59.1% adherence rate at 5 years and 50% at 10 years [31]. Baron et al. also described similar adherence rates (5 years: 63.9%; 10 years: 49.1%) [47]. The most common reasons for discontinuation were lack of efficacy and AEs, such as UTI, urinary retention, and hematuria [28].
Adherence to detrusor BoNT-A injections in SCI patients is highly associated with the treatment outcome [46]. Repeated injections allow the maintenance of favorable effects and hence, greater patient satisfaction [28][46]. However, SCI patients with voiding dysfunction are not equally satisfied with long-term urethral sphincter BoNT-A injections as they are with detrusor injections [48]. Only 35.6% of patients continued urethral sphincter BoNT-A injection therapy during a median follow-up of five years [48]. The low satisfaction rates after urethral sphincter injection were mainly caused by a high incontinence grade, inefficient therapeutic efficacy, and failure to help them wean off of CIC [48].

4. Adverse Events Related to BoNT-A Injections

The most common AEs with BoNT-A detrusor injections are symptomatic UTI, urinary retention, and hematuria [49]. BoNT-A detrusor injections are effective in reducing detrusor pressure and urinary incontinence and increasing maximal bladder capacity [49]. However, they also impair detrusor contractility leading to subsequent large PVR or urinary retention. Although BoNT-A urethral sphincter injection can facilitate bladder emptying and increase the flow rate (duration around three to nine months), it also enhances the risk of urinary incontinence, urgency sensation, and de novo frequency [48]; seldom, patients may be disappointed by the AEs that exceed the therapeutic effect. Largely, dissatisfaction with BoNT-A urethral sphincter injection is rooted in amplified urinary incontinence, whereas larger PVR requiring CIC is the primary reason for discontent with detrusor injection [44].
Intolerable AEs often cause patients to forsake repeat BoNT-A injections, although these patients can achieve complete dryness after detrusor injections. Chen et al. retrospectively reviewed 223 patients with chronic SCI who received BoNT-A detrusor injections for NDO and urinary incontinence; only 108 patients (48.4%) continued with repeat injections during the mean ten-year follow-up [5]. Among those discontinuing BoNT-A therapy, 41 patients (46.6%) discontinued due to UTIs, while 15 patients (17%) deferred due to the burden of CIC. Likewise, Hebert et al. reviewed 128 SCI patients receiving repeated detrusor BoNT-A injections for NDO, of which 58 discontinued therapy over a median follow-up of ten years [31]. Seventeen patients stopped therapy due to AEs despite the therapeutic efficacy of detrusor BoNT-A injection.

This entry is adapted from the peer-reviewed paper 10.3390/toxins15040288

References

  1. Schurch, B.; Hauri, D.; Rodic, B.; Curt, A.; Meyer, M.; Rossier, A.B. Botulinum—A toxin as a treatment of detrusor-sphincter dyssynergia: A prospective study in 24 spinal cord injury patients. J. Urol. 1996, 155, 1023–1029.
  2. Dykstra, D.D.; Sidi, A.A. Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: A double-blind study. Arch. Phys. Med. Rehabil. 1990, 71, 24–26.
  3. Reitz, A.; Stohrer, M.; Kramer, G.; Del Popolo, G.; Chartier-Kastler, E.; Pannek, J.; Burgdorfer, H.; Gocking, K.; Madersbacher, H.; Schumacher, S.; et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur. Urol. 2004, 45, 510–515.
  4. Schurch, B.; Stohrer, M.; Kramer, G.; Schmid, D.M.; Gaul, G.; Hauri, D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: A new alternative to anticholinergic drugs? Preliminary results. J. Urol. 2000, 164, 692–697.
  5. Chen, S.F.; Jiang, Y.H.; Jhang, J.F.; Kuo, H.C. Satisfaction with Detrusor OnabotulinumtoxinA Injections and Conversion to Other Bladder Management in Patients with Chronic Spinal Cord Injury. Toxins 2022, 14, 35.
  6. Jiang, Y.H.; Chen, S.F.; Kuo, H.C. Frontiers in the Clinical Applications of Botulinum Toxin A as Treatment for Neurogenic Lower Urinary Tract Dysfunction. Int. Neurourol. J. 2020, 24, 301–312.
  7. Kennelly, M.; Cruz, F.; Herschorn, S.; Abrams, P.; Onem, K.; Solomonov, V.K.; Del Rosario Figueroa Coz, E.; Manu-Marin, A.; Giannantoni, A.; Thompson, C.; et al. Efficacy and Safety of AbobotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Incontinence Performing Regular Clean Intermittent Catheterization: Pooled Results from Two Phase 3 Randomized Studies (CONTENT1 and CONTENT2). Eur. Urol. 2022, 82, 223–232.
  8. Cruz, F.; Danchenko, N.; Fahrbach, K.; Freitag, A.; Tarpey, J.; Whalen, J. Efficacy of abobotulinumtoxinA versus onabotulinumtoxinA for the treatment of refractory neurogenic detrusor overactivity: A systematic review and indirect treatment comparison. J. Med. Econ. 2023, 26, 200–207.
  9. Cruz, F.; Herschorn, S.; Aliotta, P.; Brin, M.; Thompson, C.; Lam, W.; Daniell, G.; Heesakkers, J.; Haag-Molkenteller, C. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: A randomised, double-blind, placebo-controlled trial. Eur. Urol. 2011, 60, 742–750.
  10. Apostolidis, A.; Thompson, C.; Yan, X.; Mourad, S. An exploratory, placebo-controlled, dose-response study of the efficacy and safety of onabotulinumtoxinA in spinal cord injury patients with urinary incontinence due to neurogenic detrusor overactivity. World J. Urol. 2013, 31, 1469–1474.
  11. Giannantoni, A.; Mearini, E.; Del Zingaro, M.; Porena, M. Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: Clinical and urodynamic results. Eur. Urol. 2009, 55, 705–711.
  12. Kennelly, M.; Dmochowski, R.; Ethans, K.; Karsenty, G.; Schulte-Baukloh, H.; Jenkins, B.; Thompson, C.; Li, D.; Haag-Molkenteller, C. Long-term efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: An interim analysis. Urology 2013, 81, 491–497.
  13. Rovner, E.; Dmochowski, R.; Chapple, C.; Thompson, C.; Lam, W.; Haag-Molkenteller, C. OnabotulinumtoxinA improves urodynamic outcomes in patients with neurogenic detrusor overactivity. Neurourol. Urodyn. 2013, 32, 1109–1115.
  14. Schurch, B.; de Seze, M.; Denys, P.; Chartier-Kastler, E.; Haab, F.; Everaert, K.; Plante, P.; Perrouin-Verbe, B.; Kumar, C.; Fraczek, S.; et al. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: Results of a single treatment, randomized, placebo controlled 6-month study. J. Urol. 2005, 174, 196–200.
  15. Akbar, M.; Abel, R.; Seyler, T.M.; Bedke, J.; Haferkamp, A.; Gerner, H.J.; Mohring, K. Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction. BJU Int. 2007, 100, 639–645.
  16. Mangera, A.; Apostolidis, A.; Andersson, K.E.; Dasgupta, P.; Giannantoni, A.; Roehrborn, C.; Novara, G.; Chapple, C. An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur. Urol. 2014, 65, 981–990.
  17. Schurch, B.; Denys, P.; Kozma, C.M.; Reese, P.R.; Slaton, T.; Barron, R.L. Botulinum toxin A improves the quality of life of patients with neurogenic urinary incontinence. Eur. Urol. 2007, 52, 850–858.
  18. Game, X.; Castel-Lacanal, E.; Bentaleb, Y.; Thiry-Escudie, I.; De Boissezon, X.; Malavaud, B.; Marque, P.; Rischmann, P. Botulinum toxin A detrusor injections in patients with neurogenic detrusor overactivity significantly decrease the incidence of symptomatic urinary tract infections. Eur. Urol. 2008, 53, 613–618.
  19. Patki, P.S.; Hamid, R.; Arumugam, K.; Shah, P.J.; Craggs, M. Botulinum toxin-type A in the treatment of drug-resistant neurogenic detrusor overactivity secondary to traumatic spinal cord injury. BJU Int. 2006, 98, 77–82.
  20. Dowson, C.; Khan, M.S.; Dasgupta, P.; Sahai, A. Repeat botulinum toxin-A injections for treatment of adult detrusor overactivity. Nat. Rev. Urol. 2010, 7, 661–667.
  21. Koschorke, M.; Leitner, L.; Sadri, H.; Knupfer, S.C.; Mehnert, U.; Kessler, T.M. Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: Do we need urodynamic investigation for outcome assessment? BJU Int. 2017, 120, 848–854.
  22. Krhut, J.; Samal, V.; Nemec, D.; Zvara, P. Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: A pilot study. Spinal Cord 2012, 50, 904–907.
  23. Samal, V.; Mecl, J.; Sram, J. Submucosal administration of onabotulinumtoxinA in the treatment of neurogenic detrusor overactivity: Pilot single-centre experience and comparison with standard injection into the detrusor. Urol. Int. 2013, 91, 423–428.
  24. Abdel-Meguid, T.A. Botulinum toxin-A injections into neurogenic overactive bladder--to include or exclude the trigone? A prospective, randomized, controlled trial. J. Urol. 2010, 184, 2423–2428.
  25. Hui, C.; Keji, X.; Chonghe, J.; Ping, T.; Rubiao, O.; Jianweng, Z.; Xiangrong, D.; Liling, Z.; Maping, H.; Qingqing, L.; et al. Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity. Spinal Cord 2016, 54, 46–50.
  26. Chen, H.; Xie, K.; Jiang, C. A single-blind randomized control trial of trigonal versus nontrigonal Botulinum toxin-A injections for patients with urinary incontinence and poor bladder compliance secondary to spinal cord injury. J. Spinal Cord Med. 2021, 44, 757–764.
  27. Jo, J.K.; Kim, K.N.; Kim, D.W.; Kim, Y.T.; Kim, J.Y.; Kim, J.Y. The effect of onabotulinumtoxinA according to site of injection in patients with overactive bladder: A systematic review and meta-analysis. World J. Urol. 2018, 36, 305–317.
  28. Ni, J.; Wang, X.; Cao, N.; Si, J.; Gu, B. Is repeat Botulinum Toxin A injection valuable for neurogenic detrusor overactivity—A systematic review and meta-analysis. Neurourol. Urodyn. 2018, 37, 542–553.
  29. Alvares, R.A.; Araujo, I.D.; Sanches, M.D. A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics. BMC Urol. 2014, 14, 66.
  30. Joussain, C.; Popoff, M.; Phe, V.; Even, A.; Bosset, P.O.; Pottier, S.; Falcou, L.; Levy, J.; Vaugier, I.; Chartier Kastler, E.; et al. Long-term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity. Neurourol. Urodyn. 2018, 37, 799–806.
  31. Hebert, K.P.; Klarskov, N.; Bagi, P.; Biering-Sorensen, F.; Elmelund, M. Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury. Spinal Cord 2020, 58, 675–681.
  32. Denys, P.; Dmochowski, R.; Aliotta, P.; Castro-Diaz, D.; Blok, B.; Ethans, K.; Aboushwareb, T.; Magyar, A.; Kennelly, M. Positive outcomes with first onabotulinumtoxinA treatment persist in the long term with repeat treatments in patients with neurogenic detrusor overactivity. BJU Int. 2017, 119, 926–932.
  33. Hamid, R.; Averbeck, M.A.; Chiang, H.; Garcia, A.; Al Mousa, R.T.; Oh, S.J.; Patel, A.; Plata, M.; Del Popolo, G. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World J. Urol. 2018, 36, 1517–1527.
  34. Weld, K.J.; Dmochowski, R.R. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology 2000, 55, 490–494.
  35. Ginsberg, D.; Gousse, A.; Keppenne, V.; Sievert, K.D.; Thompson, C.; Lam, W.; Brin, M.F.; Jenkins, B.; Haag-Molkenteller, C. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J. Urol. 2012, 187, 2131–2139.
  36. Kuo, H.C. Therapeutic effects of suburothelial injection of botulinum a toxin for neurogenic detrusor overactivity due to chronic cerebrovascular accident and spinal cord lesions. Urology 2006, 67, 232–236.
  37. Dykstra, D.D.; Sidi, A.A.; Scott, A.B.; Pagel, J.M.; Goldish, G.D. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J. Urol. 1988, 139, 919–922.
  38. Kuo, H.C. Satisfaction with urethral injection of botulinum toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion. Neurourol. Urodyn. 2008, 27, 793–796.
  39. Smith, C.P.; Nishiguchi, J.; O’Leary, M.; Yoshimura, N.; Chancellor, M.B. Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra. Urology 2005, 65, 37–41.
  40. Kuo, H.C. Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia. Int. J. Clin. Pract. 2013, 67, 1044–1049.
  41. Mahfouz, W.; Karsenty, G.; Corcos, J. Injection of botulinum toxin type A in the urethral sphincter to treat lower urinary tract dysfunction: Review of indications, techniques and results: 2011 update. Can. J. Urol. 2011, 18, 5787–5795.
  42. Huang, Y.H.; Chen, S.L. Concomitant Detrusor and External Urethral Sphincter Botulinum Toxin-A Injections in Male Spinal Cord Injury Patients with Detrusor Overactivity and Detrusor Sphincter Dyssynergia. J. Rehabil. Med. 2022, 54, jrm00264.
  43. Huang, M.; Chen, H.; Jiang, C.; Xie, K.; Tang, P.; Ou, R.; Zeng, J.; Liu, Q.; Li, Q.; Huang, J.; et al. Effects of botulinum toxin A injections in spinal cord injury patients with detrusor overactivity and detrusor sphincter dyssynergia. J. Rehabil. Med. 2016, 48, 683–687.
  44. Kuo, H.C. Therapeutic satisfaction and dissatisfaction in patients with spinal cord lesions and detrusor sphincter dyssynergia who received detrusor botulinum toxin a injection. Urology 2008, 72, 1056–1060.
  45. Dahlberg, A.; Perttila, I.; Wuokko, E.; Ala-Opas, M. Bladder management in persons with spinal cord lesion. Spinal Cord 2004, 42, 694–698.
  46. Hori, S.; Patki, P.; Attar, K.H.; Ismail, S.; Vasconcelos, J.C.; Shah, P.J. Patients’ perspective of botulinum toxin-A as a long-term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury. BJU Int. 2009, 104, 216–220.
  47. Baron, M.; Peyronnet, B.; Auble, A.; Hascoet, J.; Castel-Lacanal, E.; Miget, G.; Le Doze, S.; Prudhomme, T.; Manunta, A.; Cornu, J.N.; et al. Long-Term Discontinuation of Botulinum Toxin A Intradetrusor Injections for Neurogenic Detrusor Overactivity: A Multicenter Study. J. Urol. 2019, 201, 769–776.
  48. Lee, C.L.; Jhang, J.F.; Jiang, Y.H.; Kuo, H.C. Real-World Data Regarding Satisfaction to Botulinum Toxin A Injection into the Urethral Sphincter and Further Bladder Management for Voiding Dysfunction among Patients with Spinal Cord Injury and Voiding Dysfunction. Toxins 2022, 14, 30.
  49. Li, G.P.; Wang, X.Y.; Zhang, Y. Efficacy and Safety of OnabotulinumtoxinA in Patients With Neurogenic Detrusor Overactivity Caused by Spinal Cord Injury: A Systematic Review and Meta-analysis. Int. Neurourol. J. 2018, 22, 275–286.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
This entry is offline, you can click here to edit this entry!
Video Production Service
Feedback