There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa .
CONCLUSION 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 .
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 aim ed 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 .
Botulinum toxin-A injections into neurogenic overactive bladder--to include or exclude the trigone? A prospective, randomized, controlled trial.
PURPOSE The short-term outcomes of initial detrusor injections vs combined detrusor-trigone botulinum toxin-A injections were determined in patients with spinal cord injury-neurogenic detrusor overactivity . MATERIAL S AND METHODS Adults with refractory spinal cord injury-neurogenic detrusor overactivity who strictly discontinued anticholinergics were recruited for the study . At a 1:1 ratio patients r and omly received 300 U botulinum toxin-A intradetrusor injections excluding the trigone ( detrusor arm ) or 200 U intradetrusor plus 100 U intratrigonal injections ( combined arm ) . Study end points were determination of the impact on incontinence episodes , complete dryness , quality of life , reusing anticholinergics , maximum detrusor pressure , reflex volume , maximum cystometric capacity , vesicoureteral reflux and adverse events . Patients were evaluated at baseline , and 2 , 8 , 12 and 18 weeks after injection . Statistical significance was considered at p<0.05 . RESULTS Analysis included 18 patients per arm with no significant baseline differences . On within group analysis all parameters improved significantly compared to baseline . On between group analysis in the detrusor vs the combined arm at week 8 incontinence decreased by 52.4 % vs 80.9 % ( number needed to treat 1.91 vs 1.23 patients , p<0.001 ) , complete dryness was achieved in 33.3 % vs 66.7 % of patients ( number needed to treat 3 vs 1.5 , p<0.001 ) and quality of life score was decreased by 46.76 % vs 48.13 % ( number needed to treat 2.14 vs 2.08 , p<0.44 ) . The absolute difference was 60 % vs 82.5 % for reflex volume ( p<0.001 ) , 66.2 % vs 68.4 % for maximum cystometric capacity ( p<0.22 ) and -42.3 % vs -41.9 % for maximum detrusor pressure ( p<0.21 ) . At week 18 anticholinergics were needed again in 9 ( 50 % ) and 4 patients ( 22.2 % ) patients , respectively . No patient showed new or up grade d vesicoureteral reflux or reported significant adverse events . CONCLUSIONS In the short term all parameters improved significantly in each arm . The superiority of including rather than excluding the trigone was significant
There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa .
CONCLUSION 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 .
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 aim ed 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 .