Treatment of Neurogenic Detrusor Overactivity after Spinal Cord Injury Using Botulinum A Toxin. Comparison of Endoscopic Submucosal and Intramuscular Route of Application

Czech version

Authors: V. Šámal ¹; J. Mečl ¹; J. Šrám ²
Authors‘ workplace: Krajská nemocnice Liberec, a. s. Urologické oddělení ¹; Krajská nemocnice Liberec, a. s. Traumatologicko-ortopedické centrum, Spinální jednotka ²
Published in: Cesk Slov Neurol N 2012; 75/108(2): 197-202
Category: Original Paper

Overview

Treatment of neurogenic detrusor overactivity using botulinum A toxin is currently the approach of choice in patients refractory to antimuscarinic drugs. This study compares the changes of urodynamic parameters with different routes of botulinum A toxin administration – submucosal and intramuscular. The study monitors changes in selected urodynamic parameters and the number of incontinence episodes as well as an improvement in the quality of life.

Material and methods:
Fifteen patients with neurogenic detrusor overactivity after spinal cord injury aged 25 to 46 year were randomized into two groups to receive 300 U of botulinumtoxin (Botox^®) by cystoscopic approach. In group A, the drug submucosaly and it was administered into detrusor in group B. Urodynamic parameters and the quality of life were evaluated before and 12 weeks after the treatment.

Results:
The authors present results obtained from 15 patients. The number of incontinence episodes decreased after the treatment in about 77% of patients in both groups. Maximum cystometric capacity increased from 236.6 ±76.1 ml to 456 ±73.8 ml in the group with submucosal application (p <0.05) and from 242.7 ±96.8 ml to 432.8 ±79.1 ml in the group with the application into detrusor (p <0.05). Maximum detrusor pressure during involuntary contraction decreased (p <0.05).

Conclusion:
Administration of botulinum A toxin within 3 months after treatment increased the maximum cystometric capacity, decreased maximum detrusor pressure during involuntary detrusor contraction and reduced the number of incontinence episodes. These preliminary results suggest that both methods of administration are comparable.

Key words:
botulinum toxin – detrusor overactivity – incontinence – submucosal application

Sources

1. Leippold T, Reitz A, Schurch B. Botulinum toxin as a new therapy option for voiding disorders: current state of the art. Eur Urol 2003; 44(2): 165–174.

2. Dong M, Yeh F, Tepp WH, Johnson EA, Janz R, Chapman ER. SV2 is the protein receptor for botulinum neurotoxin A. Science 2006; 312(5773): 592–596.

3. Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford A, Davis J et al. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibres following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol 2005; 174(3): 977–983.

4. Giannantoni A, Di Stasi SM, Nadricchi V, Zuchi A, Machcioni L, Bini V et al. Botulinum-A toxin injections into the detrusor muscle decrease nerve growth factor bladder tissue levels in patients with neurogenic detrusor overactivity. J Urol 2006; 175(6): 2341–2344.

5. Haferkapm A, Schurch B, Reitz A, Krengel U, Grosse J, Kramer G et al. Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type A in overactive neuorogenic bladder. Eur Urol 2004; 46(6): 784–791.

6. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61(1): 37–49.

7. Hintze J. NCSS and PASS, Number Crundur Statistical Systems, Kaysville, Utah, US, 2001. Available from: http://www.NCSS.com.

8. Patel AK, Patterson JM, Chapple CR. Botulinum Toxin injections for neurogenic and idiopathic detrusor overactivity: A critical analysis of results. Eur Urol 2006; 50(4): 684–710.

9. Mehnert U, Boy S, Schmid M, Reitz A, von Hessling A, Hodler J et al. A morphological evaluation of botulinum neurotoxin A injections into detrusor muscle using magnetic resonance imaging. World J Urol 2009; 27(3): 397–409.

10. Boy S, Schmid M, Reitz A, Von Hessling A, Hodler J, Schurch B. Botulinum toxin injections into the bladder wall – a morphological evaluation of the injections technique using magnetic resonance imaging. Eur Urol 2006; 2 (Suppl 5): 299.

11. Kuo HC. Comparison of effectiveness of detrusor, suburothelial and bladder base injection of botulinum toxin A for idiopathic detrusor overactivity. J Urol 2007; 178(4): 1359–1363.

12. Karsenty G, Denys P, Amarenco G, De Seze M, Gamé X, Haab F et al. Botulinum toxin A (Botox®) intradetrusor injections in adults with neurogenic detrusor overactivity /neurogenic overactive bladder: a systematic literature review. Eur Urol 2008; 53(2): 275–287.

13. Krhut J, Kopecký J, Hradílek P, Zapletalová O, Tvrdík J. Využití léčby neurogenních dysfunkcí dolních cest močových aplikací botulinumtoxinu do detruzoru. Ces Urol 2007; 11(3): 154–158.

14. Krhut J, Zvara P. Intravesical instillation of butulinum toxin A: an in vivo murine study and pilot clinical trial. Int Urol Nephrol 2011; 43(2): 337–343.

15. Giannantoni A, Mearini E, Del Zengrano M, Perena M. Six year follow-up of botulinum toxin A intradetrusorial injection in patient with refractory neurogenic detrusor overactivity: clinical and urodynamic results. Eur Urol 2009; 55(3): 705–711.

16. Highlights from the World Health Organization 2nd International Consultation on Incontinence 2001, July 1–4, Paris, France. Available from: http://www.icsoffice.org/Publications/ICI_2/MENUS/MAIN.PDF.

17. Bushnell DM, Martin ML, Summers KH, Svihra J, Lionis C, Patrick DL. Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL. Qual Life Res 2005; 14(8): 1901–1913.

18. Kalsi V, Apostolidis A, Popat R, Gonzales G, Fowler CJ, Daskygypta P et al. Quality of life changes in patient with neurogenic versus idopatic detrusor overactivity after intradetrusor injections of botulinum neurotoxin type A and corelations with lower urinary tract symptoms and urodynamic changes. Eur Urol 2006; 49(3): 528–535.

19. Schurch B, Denys P, Kozma CM, Reese PR, Slaton T, Barron RL. Botulinum toxin A improves the quality of life of patients with neurogenic urinary inkontinence. Eur Urol 2007; 52(3): 850–859.

20. Truzzi JC, Bruschini H, Simonetti R, Miguel S. What is the best dose for intravesical botulinum A toxin injection in overactive bladder treatment? A prospective randomised preliminary study. Join Meeting of the International Continence Society (ICS) and the International Uro-Gynecological association (IUGA); 2004 Aug 25–27; Paris, France (abstract 254).

21. Gausse A, Tunuguntla HS, Rodroiguez G, Velzazquez D. Dose finding prospective randomized study to evaluate the efficacy and safety of botulinum A toxin for refractory idiopathic overactive bladder. International Continence Society Annual Meeting; 2005 Aug 28–Sep 02; Montreal, Canada (abstract 254).

22. Schurch B, Stöhrer M, Kramer G. Botulinum toxin A to treat detrusor hyperreflexia in spinal cord injured patient. Neurourol Urodyn 2001; 20: 521–522.

23. Wenzel R, Jones D, Borrego JA, Comparing two botulinum toxin type A formulations using manufacturers´ product summaries. J Clin Pharm Ther 2007; 32(4): 387–402.