Long-term neurogenic lower urinary tract dysfunction: A case of cardiovascular nightmares

This case report discusses the limitations of using onabotulinumtoxinA injections to treat autonomic dysreflexia (AD) and improve lower urinary tract (LUT) function in individuals with spinal cord injury (SCI). The report focuses on a 46-year-old man with a long-standing SCI who experienced persistent AD despite receiving this treatment. The patient, who had relied on an indwelling urethral catheter for bladder emptying due to impaired hand function, underwent intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity (NDO) and associated AD. Although the treatment slightly improved LUT function, severe bladder-related AD persisted. The authors suggest that urinary diversion should be considered to protect the individual's urinary tract and eliminate bladder-related AD consequences long-term. Early treatment and management of NDO and AD are crucial to minimize complications.

• 1
  Intradetrusor onabotulinumtoxinA injections, while slightly improving LUT function, did not resolve severe bladder-related AD in a patient with longstanding SCI.
• 2
  Structural changes in the urinary bladder, such as trabeculation resulting from long-term SCI, may limit the efficacy of onabotulinumtoxinA injections.
• 3
  Continuing bladder management with an indwelling catheter is not advisable due to risks such as decreased bladder capacity, increased UTI odds, and bladder stone formation.