Spastic Neurogenic Bladder Clinical Trial
Official title:
The Efficacy of Botulinum Toxin in Spastic Neuropathic Bladder
To assess the efficacy of botulinum toxin in spastic neurogenic bladder.
Neurogenic detrusor overactivity (NDO) can result in lower and upper urinary tract
complications and eventually even in end-stage kidney failure. Since the driving force of
this clinical cascade is high bladder pressure, controlling intravesical pressure in NDO
patients improves both quality of life and life-expectancy in these patients. Botulinum toxin
A (BTX-A) has proven its efficacy in reducing intravesical pressure and in reducing
incontinence episodes. BTX-A also improves quality of life in patients with NDO. Both
onabotulinumtoxinA (Botox®, Allergan, Irvine, USA) and abobotulinumtoxinA (Dysport®, Ipsen,
Paris, France) have a level A recommendation for NDO-treatment. The recommended dose for
intradetrusor injections in NDO patients is 200 U of onabotulinumtoxinA or 500 U of
abobotulinumtoxinA. The drug is generally administered extratrigonal in the detrusor muscle,
via cystoscopic guided injection at 20 sites in 1 mL injections. Intradetrusor BTX-A
injections are safe, with mostly local complications such as urinary tract infection and high
post-void residual or retention. The effect of the toxin lasts for approximately 9 months.
Repeat injections can be performed without loss of efficacy. Different injection techniques,
novel ways of BTX-A administration, eliminating the need for injection or new BTX-A types
with better/longer response rates could change the field in the future.
Botulinum toxins are neurotoxins produced by the facultative anaerobe Clostridium botulinum
that block the release of acetylcholine into the synaptic gap of the neuromuscular junction.
Their injection near the nerves that supply the target organ selectively and temporarily
paralyzes the organ. In particular, the subtype botulinum-A toxin is widely used in neurology
to release spastic dystonia in adults and children . In urologic disorders, botulinum-A toxin
reliably diminishes external sphincter or detrusor overactivity.
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