OBJECTIVE: To examine the effectiveness of botulinum toxin A (BTX A) on neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI).
DATA SOURCES: Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to June 2012.
DATA SELECTION: Trials examining the use of BTX-A injections into the detrusor wall in treatment of NDO after SCI were included if ≥ 50% of study sample was comprised of subjects post SCI, outcomes of interest were assessed before and after treatment with a single injection of BTX and if the sample size was ≥3.
DATA EXTRACTION: A standardized mean difference (SMD) ± standard error (95% confidence interval, CI) was calculated for at least one of the following outcomes in every study: post-void residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, catheterization frequency, and max flow rate. Results from all studies were then pooled using a random effects model. Treatment effect sizes were interpreted as: small >0.2, moderate>0.5, or large >0.8.
DATA SYNTHESIS: Fourteen studies representing data from 734 subjects were included. Post BTX A injection, large treatment effects were observed in post-void residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, and catheterization frequency (p< 0.01). Rate of incontinence episodes was reduced from 23% to 1.31% post BTX-A treatment. No significant decrease in max flow rate was observed (p=0.403).
CONCLUSION: Results of the meta-analysis indicate BTX-A is effective in treating NDO after SCI. The use of BTX-A was associated with a decrease in incontinence episodes, catheter use and bladder pressures.
Written by:
Mehta S, Hill D, McIntyre A, Foley N, Hsieh J, Ethans K, Teasell RW, Loh E, Welk B, Wolfe D. Are you the author?
Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON; St. Joseph's Health Care, Parkwood Hospital, London ON.
Reference: Arch Phys Med Rehabil. 2013 Apr 27. pii: S0003-9993(13)00317-1.
doi: 10.1016/j.apmr.2013.04.011
PubMed Abstract
PMID: 23632286
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