Intradetrusor OnabotulinumtoxinA Injections Ameliorate Autonomic Dysreﬂexia while Improving Lower Urinary Tract Function and Urinary Incontinence-Related Quality of Life in Individuals with Cervical and Upper Thoracic Spinal Cord Injury

JOURNAL OF NEUROTRAUMA, 2020 · DOI: 10.1089/neu.2020.7115 · Published: September 15, 2020

Simple Explanation

This study investigated the effects of onabotulinumtoxinA injections on autonomic dysreflexia (AD) and urinary function in individuals with spinal cord injury (SCI). The study found that the injections reduced AD severity and improved urinary incontinence-related quality of life. The treatment increased bladder capacity and reduced bladder pressure. Minor complications were recorded in some participants, but the treatment was generally well-tolerated. The benefits were observed in both individuals with cervical and upper thoracic SCI, suggesting that onabotulinumtoxinA injections can be an effective treatment option for managing AD and improving urinary function in this population.

Study Duration

1 Month Follow-up

Participants

34 individuals with cervical and upper thoracic spinal cord injury

Evidence Level

Level IV, Prospective phase IV clinical trial

Key Findings

1
AD severity decreased in 82% of participants during urodynamic studies (UDS) and in 74% in daily life.
2
Urinary incontinence-related quality of life improved, cystometric capacity increased, and maximum detrusor pressure during storage decreased significantly.
3
Injury-level-dependent analysis revealed a lower incidence and lesser severity of AD during UDS in individuals with cervical SCI compared to those with upper thoracic SCI.

Research Summary

This study evaluated the effect of intradetrusor onabotulinumtoxinA injections on autonomic dysreflexia (AD) and lower urinary tract (LUT) function in individuals with cervical and upper thoracic spinal cord injury (SCI). The study found that the injections significantly reduced AD severity during urodynamics and in daily life. LUT function also improved with increased cystometric capacity and decreased maximum detrusor pressure. The authors concluded that intradetrusor onabotulinumtoxinA injections are an effective and safe treatment to ameliorate AD, improve LUT function, and enhance urinary incontinence-related quality of life in individuals with cervical and upper thoracic SCI.

Practical Implications

Clinical Practice

Intradetrusor onabotulinumtoxinA injections can be considered as a second-line treatment option for managing AD and improving lower urinary tract function in individuals with cervical and upper thoracic SCI.

Quality of Life

The treatment can lead to significant improvements in urinary incontinence-related quality of life for individuals with SCI, enhancing their overall well-being.

Cardiovascular Risk

By ameliorating AD, the treatment may reduce the risk of life-threatening cardiovascular consequences in individuals with SCI.

Study Limitations

1
Small sample size, particularly in the upper thoracic SCI group, which may have limited the statistical power to detect significant differences in some outcome parameters.
2
The study design was a pre-post study without a control group, making it difficult to attribute the observed improvements solely to the onabotulinumtoxinA injections.
3
The follow-up period was relatively short (one month), and longer-term effects of the treatment were not assessed.

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