Ces Urol 2007, 11(3):77-81 | DOI: 10.48095/cccu2007016

Results of therapy of neurogenic lower urinary tract dysfunction with detrusor injections of botulinum toxin

J. Krhut¹, J. Kopecký¹, P. Hradílek², O. Zapletalová², J. Tvrdík³

¹ Urologické oddělení FN, Ostrava-Poruba

² Neurologická klinika FN, Ostrava-Poruba

³ Katedra informatiky Ostravská univerzita, Ostrava

Introduction: Neurogenic lower urinary tract dysfunction (NLUTD) significantly decreases the quality of life of patients and, in some cases, may markedly impair the function of the upper urinary tract. The standard first-choice treatment in these patients is administration of anticholinergic drugs, however, in some patients, this treatment fails to work.
While in the past these patients were mostly offered radical surgical treatment, recently therapy with botulinum toxin (BTX) has become available.
Our objective was to assess efficacy and safety of this therapeutic procedure in our own cohort of patients.

Material and methods: Our cohort included a total of 42 patients with NLUTD treated with BTX injections between May 2001 and June 2006. There were 29 men and 13 women with a median age of 31.3 (8-59) years. Regarding the aetiology of NLUTD, the cohort consisted of patients with traumatic spinal cord lesion (SCL), patients with multiple sclerosis (MS), and patients with congenital dysraphisms (MMC). In all the cases, first-choice conservative therapy failed to work.
The preparation used in all the cases was Dysport? at a dose of 1000 Ul per 1 application in adults. BTX was injected using a flexible needle into 40 sites in the detrusor during a brief endoscopic procedure. Subjective satisfaction, urodynamic parameters, and duration of effect were assessed.

Results: In the group of patients with traumatic SCL, subjective satisfaction with the treatment result was achieved in 22 (75.9%) patients. In 17 (58.6%) patients, complete continence was achieved, eight (27.6%) achieved day continence. There was an increase in cystometric capacity from 194.8 to 317ml and a decrease in detrusor pressure from 76.2 to 33.8cm H20. The duration of treatment effect was 6.6 (3-9) months.
In the subgroup of patients with MS, subjective satisfaction with the treatment result was achieved in all nine (100%) subjects. All the nine (100%) female patients also achieved complete continence.
There was an increase in cystometric capacity from 178.2 to 462.2ml and a decrease in detrusor pressure from 52.2 to 10.4cm H20. The duration of treatment effect was 12.3 (8-15) months.
In the subgroup of patients with MMC, subjective satisfaction with the treatment result was achieved in three (75%) patients. Two (50%) patients achieved complete continence, one female patient (25%) achieved day continence.
There was an increase in cystometric capacity from 221.7 to 318.5ml and a decrease in detrusor pressure from 58.5 to 23.3cm H20. The duration of treatment effect was 8.25 (7-9) months.

Conclusion: Application of BTX into detrusor is an effective and safe treatment method in refractory cases of neurogenic detrusor hyperactivity. However, further studies focused primarily on the relationships between dose, dilution, and clinical effect need to be conducted in order to standardize therapy.

Keywords: botulinum toxin, detrusor hyperactivity, continence, cystometric capacity, detrusor pressure

Published: June 1, 2007