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Botulinum toxin A in the treatment of spinal cord injury patients with refractory neurogenic detrusor overactivity
Alvares, Ronaldo A; Silva, Jose A. F; Barboza, Andre L; Monteiro, Raphael T. M.
  • Alvares, Ronaldo A; s.af
  • Silva, Jose A. F; s.af
  • Barboza, Andre L; s.af
  • Monteiro, Raphael T. M; s.af
Int. braz. j. urol ; 36(6): 732-737, Dec. 2010. tab
Article in English | LILACS | ID: lil-572402
ABSTRACT

PURPOSE:

To evaluate the efficacy of botulinum toxin type A injections in the detrusor muscle in patients with spinal cord injury and urinary incontinence due to detrusor overactivity and refractory to anticholinergic agents. MATERIALS AND

METHODS:

We prospectively evaluated 22 patients with spinal cord injuries, whose bladders were emptied by intermittent catheterization. All patients had detrusor overactivity and urinary incontinence that proved difficult to treat, despite using high doses of two different anticholinergics. The pre-treatment assessment included a complete urodynamic study and ultrasonography of the kidneys and urinary tract. A one-month follow-up was completed with urodynamic evaluation and the clinical response was evaluated through outpatient consultations and telephone contact.

RESULTS:

After the procedure, the maximum cystometric capacity and the bladder reflex volume increased, whereas the maximum detrusor pressure and compliance decreased. The mean duration of continence was 7 ± 7 months. In 18 patients (81.8 percent), it was necessary to administer anticholinergics to achieve continence. Five patients (22.7 percent) had indication of reinjection, and augmentation cystoplasty was indicated in 9 patients (40.9 percent).

CONCLUSION:

The use of botulinum toxin in the treatment of neurogenic detrusor overactivity refractory to anticholinergics is an option before more invasive treatments, such as augmentation cystoplasty, are attempted. In our study as well as in the literature, there was improvement in most urodynamic parameters. Overall, 40.9 percent of patients underwent augmentation cystoplasty and 81.8 percent of patients needed anticholinergic agents to reach urinary continence. Further studies are necessary to improve the procedure and to achieve better clinical results.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Spinal Cord Injuries / Urinary Incontinence / Cholinergic Antagonists / Botulinum Toxins, Type A / Urinary Bladder, Overactive / Neuromuscular Agents Type of study: Observational study / Prognostic study / Risk factors Limits: Adolescent / Adult / Female / Humans / Male Language: English Journal: Int. braz. j. urol Journal subject: Urology Year: 2010 Type: Article

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Full text: Available Index: LILACS (Americas) Main subject: Spinal Cord Injuries / Urinary Incontinence / Cholinergic Antagonists / Botulinum Toxins, Type A / Urinary Bladder, Overactive / Neuromuscular Agents Type of study: Observational study / Prognostic study / Risk factors Limits: Adolescent / Adult / Female / Humans / Male Language: English Journal: Int. braz. j. urol Journal subject: Urology Year: 2010 Type: Article