BACKGROUND/PURPOSE: To investigate the continuous therapeutic effects and urinary incontinence severity after repeated detrusor injections of 200-U of onabotulinumtoxinA (BoNT-A) in chronic spinal cord-injured (SCI) patients.
METHODS: Between 2006 and 2010, patients with chronic SCI and refractory neurogenic detrusor overactivity (DO) were treated with repeated sets of 200-U BoNT-A injected into 20 sites every 6 months. All patients underwent urological examinations and video-urodynamic studies at baseline and after each BoNT-A treatment. The outcomes were measured using Urogenital Distress Inventory 6-item short form (UDI-6) for urinary incontinence. The severity of urinary incontinence and urodynamic parameters were compared after each BoNT-A injection.
RESULTS: A total of 59 SCI patients with a mean age of 42.1 ± 13.1 years were enrolled. The UDI-6 incontinence scores persistently improved for up to three injections. The rate of dryness and mild incontinence reported by patients persistently improved from 25.4% at baseline to 74% at 3 months after the fourth injection, but decreased slightly after the fourth injection. The overall satisfaction rate after single or repeated injections was 59.3% (35 patients), and the failure rate was 33.9% (20 patients), and discontinuation rate owing to adverse events (2 recurrent UTI, 2 autonomic dysreflexia) was 6.8% (4 patients). Among the 20 patients who reported failure to treatment, 10 patients (16.9%) reported no significant improvement after one or repeated injections, eight converted to augmentation enterocystoplasty.
CONCLUSION: Repeated 200-U BoNT-A injections every 6 months for neurogenic DO in chronic SCI patients provided a satisfactory initial outcome. However, only 20% patients continued the repeated treatment.
Written by:
Chen SF, Kuo HC. Are you the author?
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Reference: J Formos Med Assoc. 2013 Nov 18. pii: S0929-6646(13)00364-1.
doi: 10.1016/j.jfma.2013.10.009
PubMed Abstract
PMID: 24262922
UroToday.com Overactive Bladder (OAB) Section