ABSTRACT
Objective To investigate the influence of botulinum toxin A (BTX-A) injection in detrusor muscle region and detrusor muscle combined with bladder triangle region on the symptoms severity, bladder function and quality of life in patients with neurogenic detrusor overactivity (NDO) combined with urinary incontinence. Methods Sixty patients with NDO combined with urinary incontinence were chosen in the period from March 2011 to June 2017. The patients were divided into control group and observation group according to random digits table method with 30 cases each. The patients in control group were treated with detrusor muscle region BTX-A injection, and the patients in observation group were treated with detrusor muscle combined with bladder triangle region BTX-A injection. The number of urinary incontinence for every day, detrusor muscle overactivity (DO) duration, average urine volume, bladder detrusor muscle urine storage period of maximum pressure (Pdetmax), bladder compliance (BC), volume at first involuntary detrusor muscle contraction (VFIDC), quality of life of urinary incontinence (I-QOL) score and incidences of adverse reaction before and after treatment were compared between 2 groups. Results The number of urinary incontinence every day, DO duration, average urine volume, Pdetmax, BC, VFIDC and I-QOL score after treatment in observation group were significantly better than those in control group: (2.84 ± 0.56) times vs. (6.18 ± 1.22) times, (80.05 ± 9.49) s vs. (125.16 ± 12.72) s, (378.57 ± 91.03) ml vs. (255.88 ± 75.95) ml, (30.19 ± 5.47) cmH2O (1 cmH2O=0.098 kPa) vs. (47.33 ± 7.79) cmH2O, (10.04 ± 1.71) ml/cmH2O vs. (8.09 ± 1.32) ml/cmH2O, (249.60 ± 76.19) ml vs. (195.19 ± 60.72) ml and (63.17 ± 9.60) scores vs. (54.46 ± 6.29) scores, and there were statistical differences (P＜0.05). There was no statistical difference in incidence of adverse reaction (P＞0.05). Conclusions Detrusor muscle combined with bladder triangle region BTX-A injection in patients with NDO combined with urinary incontinence relieves the symptoms severity, improves the bladder function and quality of life and not increases the adverse reactions risk.
ABSTRACT
PURPOSE: OnabotulinumtoxinA (BoNT-A) is a promising therapy for treating neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI). This systematic review and meta-analysis aimed to carry out an in-depth review and to make an objective estimation of the efficacy and safety of BoNT-A on NDO after SCI. METHODS: The PubMed, Embase, and Cochrane databases were searched for all relevant articles published from 2001 to 2016 that referred to NDO, SCI, and BoNT-A or botulinum toxin A. All data were recorded in an Excel spreadsheet by 2 individual reviewers. Review Manager version 5.3 was used to carry out the meta-analysis. RESULTS: This analysis included 17 studies involving 1,455 patients. Compared with placebo and baseline, BoNT-A was effective in increasing maximum cystometric capacity, volume at first involuntary detrusor contraction, cystometric bladder capacity (all P < 0.00001), compliance (P=0.001), and the number of patients with complete dryness (P=0.0003), and decreasing detrusor pressure, the number of patients with no involuntary detrusor contractions, the maximum flow rate, the incidence of detrusor overactivity (all P < 0.00001), and the number of urinary incontinence episodes (P=0.001). There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa. There were no life-threatening adverse events. CONCLUSIONS: BoNT-A is effective and safe in treating NDO after SCI. There were no statistically significant differences between doses of 200 U and 300 U or between injecting into the detrusor and submucosa. However, more high-quality randomized controlled trials are still needed.
Subject(s)
Humans , Botulinum Toxins , Compliance , Incidence , Spinal Cord Injuries , Spinal Cord , Urinary Bladder , Urinary IncontinenceABSTRACT
PURPOSE: OnabotulinumtoxinA is used widely for the treatment of neurogenic detrusor overactivity. We conducted a systematic review and meta-analysis to assess its efficacy and safety for neurogenic detrusor overactivity treatment. METHODS: A systematic literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for neurogenic detrusor overactivity treatment. MEDLINE, Embase, and the CENTRAL were employed. Reference lists of retrieved studies were reviewed carefully. RESULTS: Six publications involving 871 patients, which compared onabotulinumtoxinA with a placebo were analyzed. Efficacy of onabotulinumtoxinA treatment was shown as a reduction of the mean number of urinary incontinence episodes per day (mean difference, -1.41; 95% confidence interval [CI], -1.70 to -1.12; P<0.00001), maximum cystometric capacity (135.48; 95% CI, 118.22–152.75; P<0.00001), and maximum detrusor pressure (-32.98; 95% CI, -37.33 to -28.62; P<0.00001). Assessment of adverse events revealed that complications due to onabotulinumtoxinA injection were localized primarily to the urinary tract. CONCLUSIONS: This meta-analysis suggests that onabotulinumtoxinA is an effective treatment for neurogenic detrusor overactivity with localized advent events.
Subject(s)
Humans , Urinary Incontinence , Urinary TractABSTRACT
Objective To research the efficacy of different dose botulinum toxin A in the treatment of patients with neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis.Methods The datas of 43 patients with neurogenic detrusor overactivity caused by spinal cord injury or multiple sclerosis which accepted treatment in our hostipal were analyzed.And 38 patients were followed up for 12 weeks,of which 20 cases were treated with 200 U botulinum toxin A,and 18 cases received 100 U botulinum toxin A.The average age of 38 patients was 45.3 years old,and the ratio of famale was higher.The incontinence quality of life(I-QOL)changed from baselin after 6 weeks and 12 weeks was recorded.Resluts The final outcomes showed that the efficacy of botulinum toxin A with 200U was better than that with 100 U according to I-QOL score,and the difference was statistical significance(P <0.05).Conclusion The botulinum toxin A has positive effect on neurogenic detrusor overactivity,and the efficacy of 200 U injection is better than that of 100 U.
ABSTRACT
Neurogenic detrusor overactivity (NDO) often occurs after spinal cord injury, which often causes urinary tract infection, vesi-coureteral reflux, or even renal failure, and seriously impacts on the patient's quality of life. This paper reviewed the mechanism, the com-mon treatment methods, and neuromodulation theray of NDO after spinal cord injury, and elaborated percutaneous posterior tibial nerve stimulation, pudendal nerve regulation and the sacral neuromodulation respectively.
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Objective To assess the efficacy and safety of solifenacin in patients with neurogenic detrusor overactivity (NDO). Methods 50 patients with NDO received solifenacin 5 mg/d. During the treatment period, the voiding diary, Patient Perception of Bladder Condi-tion-Scale (PPBC-S) and side effects were recorded. Results 2 weeks and 12 weeks later, the volume of the catheterization every time in-creased from (224.2 ± 15.7) ml at baseline to (302.6 ± 23.3) ml and (301.3 ± 21.1) ml (P<0.05);the volume of leakage every day decreased from (753.9±121.7) ml to (444.1±87.1) ml and (449.1±89.2) ml (P<0.05);PPBC-S score decreased from (5.12±0.072) to (4.36±0.073) and (4.36±0.068) (P<0.05). There were 3 cases (6%) with dry mouth, and no patients complained dry eyes and blurred vision. Conclusion Solif-enacin is safe and effective, and can significantly improve the quality of life in patients with NDO.