Botulinum Toxin A (Botox® ) Intradetrusor Injections in Adults with Neurogenic Detrusor Overactivity/Neurogenic Overactive Bladder: A Systematic Literature Review

• Published in: European urology 2008-02, Vol.53 (2), p.275-287
• Main Authors: Karsenty, Gilles, Denys, Pierre, Amarenco, Gérard, De Seze, Marianne, Gamé, Xavier, Haab, François, Kerdraon, Jacques, Perrouin-Verbe, Brigitte, Ruffion, Alain, Saussine, Christian, Soler, Jean-Marc, Schurch, Brigitte, Chartier-Kastler, Emmanuel
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Botulinum toxin type A; Botulinum Toxins, Type A - administration & dosage; Cholinergic antagonist; Humans; Injections; Medical sciences; Nephrology. Urinary tract diseases; Neurogenic; Neuromuscular Agents - administration & dosage; Overactive bladder; Urinary bladder; Urinary Bladder, Neurogenic - drug therapy; Urinary Bladder, Neurogenic - physiopathology; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - physiopathology; Urinary incontinence; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics; Urodynamics - drug effects; Urology
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2007.10.013

Abstract Objectives This systematic literature review discusses the efficacy and safety of botulinum toxin type A (Botox® ) intradetrusor injections in adults with neurogenic detrusor overactivity (NDO) and urinary incontinence or overactive bladder symptoms of neurogenic origin (NOAB). Methods A MEDLINE and EMBASE search for clinical studies with botulinum toxin A injected into the detrusor of adults with NDO was performed. For several efficacy and safety variables data were extracted by one person and independently quality-controlled by another person. Extracted data were reviewed to propose recommendations for use in clinical practice based on level of evidence and expert opinion. Results A total of 18 articles evaluating the efficacy or safety of Botox in patients with NDO and incontinence/NOAB resistant to antimuscarinic therapy, with or without clean intermittent self-catheterisation (CIC), were selected. The amount of Botox injected was mostly 300 U, usually as 30 injections of 10 U/ml in the bladder (excluding the trigone) under cystoscopic guidance and with different types of anaesthesia. Most of the studies reported a significant improvement in clinical (approximately 40–80% of patients became completely dry between CICs) as well as urodynamic (in most studies mean maximum detrusor pressure was reduced to ≤40 cm H2 O) variables and in the patients’ quality of life, without major adverse events. Conclusions Botox injections into the detrusor provide a clinically significant improvement in adults with NDO and incontinence/NOAB refractory to antimuscarinics. It seems to be very well tolerated. However, more adequately powered, well-designed, randomised, controlled studies evaluating the optimal dose, number and location of injections, impact on antimuscarinic regimen and CIC use, duration of effect, and when to perform repeat injections are warranted.