Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review

The Journal of Spinal Cord Medicine, 2013 · DOI: 10.1179/2045772313Y.0000000116 · Published: September 1, 2013

Simple Explanation

Botulinum toxin, also known as Botox, is injected into the bladder wall to treat overactivity, especially in individuals with neurological conditions like multiple sclerosis or spinal cord injury. The treatment helps reduce urinary incontinence and enhance the quality of life by increasing bladder capacity and decreasing bladder pressure. Botulinum toxin works by blocking the release of acetylcholine, a neurotransmitter, at the neuromuscular junctions and synapses, which reduces involuntary bladder contractions.

Study Duration

Not specified

Participants

Individuals with neurogenic detrusor overactivity

Evidence Level

Review Article

Key Findings

1
Botulinum toxin A (BoNT/A) is effective in treating neurogenic detrusor overactivity (NDO) by decreasing urinary incontinence and improving urodynamic parameters.
2
BoNT/A impacts both the efferent (motor) and afferent (sensory) nerve systems in the bladder, modulating bladder activity.
3
Repeated injections of BoNT/A maintain improvements in clinical and urodynamic parameters without causing significant histological changes in the bladder wall.

Research Summary

Botulinum toxin has emerged as an excellent alternative for individuals with NDO who fail to tolerate anticholinergic medications. Its popularity has increased because of the literature, which has supported its effectiveness, safety, easy use and learning curve, reproducibility of results on repeated use, and recent FDA approval of Botox® (onabotulinumtoxinA). Further research is expected to continue to improve the effectiveness of BoNT in those with NDO.

Practical Implications

Clinical Practice

BoNT/A is a viable treatment option for NDO, particularly for those intolerant to anticholinergic medications.

Quality of Life

BoNT/A injections can lead to significant improvements in the quality of life for patients with NDO by reducing incontinence and improving bladder function.

Further Research

Continued research is needed to optimize BoNT/A injection techniques, dosages, and to better understand its long-term effects and mechanisms of action.

Study Limitations

1
Lack of standardized clinical protocols for BoNT/A injection.
2
Limited data on the interchangeability of different BoNT/A serotypes.
3
Need for more long-term studies evaluating the impact of BoNT on renal function.

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