Treatment of neurogenic detrusor overactivity using botulinumtoxin A – initial experiences with submucosal route of application

Overview

Aim:
Treatment of neurogenic detrusor overactivity using botulinum A toxin is the first option for patients refractory to antimuscarinic drugs. This study compare changes of urodynamic parameters in different route of application of botulinum A toxin – submucosal and intramuscular.

Material and methods:
Twelve patients after spinal cord injury in age between 16 and 36 year were randomised into two groups to receive 300 U of Botox^® by cystoscopic approach. In group A was drug administred submucosaly and in group B into detrusor.

Results:
Author present preliminary results of 12 patient. After treatment number of epizodes of incontinence decreased in about 69% in group with suburothelial application and in about 53% in group with intramuscular application. Maximal cystometric capacity increased from 230 ± 78 ml to 435 ± 107 ml in group with submucosal application and from 229 ± 91 ml to 410 ± 72 ml in group with application into detrusor.

Conclusion:
Application of botulinum A toxin in period 3 month after treatment increase maximal cystometric capacity and decrease detrusor pressure during first involuntary detrusor contraction. From this initial preliminary results the both route of application seems to be comparable.

Key words:
botulinum toxin, detrusor overactivity, incontinence.