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. 2022 Mar:161:146-152.
doi: 10.1016/j.urology.2021.09.045. Epub 2021 Dec 8.

Prospective Evaluation of Intradetrusor Injections of OnabotulinumtoxinA in Adults With Spinal Dysraphism

Alexander Mackay  1 , Rachel Sosland  1 , Khue Tran  1 , Julie Stewart  1 , Timothy Boone  1 , Rose Khavari  2
Affiliations

Prospective Evaluation of Intradetrusor Injections of OnabotulinumtoxinA in Adults With Spinal Dysraphism

Alexander Mackay et al. Urology. 2022 Mar.

Abstract

Objective: To prospectively evaluate the effectiveness of OnabotulinumtoxinA (BTX-A) on neurogenic overactive bladder (nOAB) in adults with congenital spinal dysraphism (CSD).

Methods: We conducted a prospective, nonrandomized pilot study of 24 adults with CSD and neurogenic overactive bladder. Patients were evaluated with baseline video-urodynamics (UDS) and validated questionnaires, underwent injection 200U BTX-A, and then underwent repeat evaluation with questionnaires and UDS 1-3 months postinjection. A high-risk subgroup was separately analyzed based on adverse clinical characteristics (ie, decrease bladder compliance, vesicoureteral reflux, hydronephrosis, chronic kidney disease).

Results: BTX-A injection improved patient recorded outcome measures seen in both I-QOL Score total (67.9 vs 75.5, P = .007) and Neurogenic Bladder Symptom Score total (38.0 vs 29.0, P = .001). On UDS, BTX-A injection significantly improved end filling pressure (16.0 vs 8.8, P = .036) and also improved bladder compliance (mL/cm H2O) (89.38 vs 135.81, P = .445). High-risk patients were found to have similar improvements in most subjective questionnaire scoring, a significant decrease in end filling pressures, and improved bladder compliance on UDS.

Conclusion: BTX-A can be used as an effective treatment in adults with CSD. We found that BTX-A significantly improved quality of life from patient reported outcome measurements as well as improving end filling pressures and bladder compliance. These improvements were seen even within our high-risk subgroup. Further studies are needed to evaluate long-term efficacy and appropriate follow-up of this at-risk population.

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Figures

Figure 1.
Figure 1.
Recruitment flowchart.
Figure 2.
Figure 2.
Incontinence- Quality of Life and Neurogenic Bladder Symptom Score questionnaire scoring before and after BTX-A treatment. *P value <.05. I-QOL- greater score value is associated with greater quality of life. NBSS- lower score value associated with greater quality of life.
See this image and copyright information in PMC

Comment in

  • Editorial Comment.
    Bowen DK. Bowen DK. Urology. 2022 Mar;161:152. doi: 10.1016/j.urology.2021.09.046. Urology. 2022. PMID: 35307076 No abstract available.
  • Trauma, and Genital and Urethral Reconstruction.
    Elliott SP. Elliott SP. J Urol. 2023 Jan;209(1):288-289. doi: 10.1097/JU.0000000000003029. Epub 2022 Oct 21. J Urol. 2023. PMID: 36268616 No abstract available.

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