Intravesical Botulinum Toxin Type A Injection Therapy in Neurological Patients

Objectives: The objective of this study is to present real-life data on the efficacy and safety of the intravesical injection of the approved dose of 200U BOTOX in patients with drug-resistant incontinence of neurogenic etiology. Available literature is relatively limited. Materials and Methods: We analyzed routinely collected prospective data from the treatment of patients with neurogenic drug-resistant incontinence who attended an academic neurourology outpatient clinic. All patients received at least one intravesical injection of 200U BOTOX, following urodynamic confirmation of neurogenic detrusor overactivity while recording the presence of urinary tract infection (UTI). Patients were followedup at 6 and 24 weeks with urodynamic retests. This protocol was followed with each repeat treatment, while recording the relapse time of incontinence. Results: Forty-nine patients (28 males, 21 females, mean age 47.04 ± 14.16 years) were treated; 18 (36.7%) suffered from spinal cord injury, 12 (24.54%) from multiple sclerosis, and the rest from other neurological conditions. Fifteen received a 2nd Botox treatment, 10 a 3rd, 6 a 4th, and one a 5th and 6th session. Forty-two (85.7%) patients had urodynamically proven incontinence and in 14 (28.6%) an UTI was identified before the first treatment. Subjective cure of incontinence was recorded in 73.7% of patients after the first treatment. There was no correlation of gender, neurological diagnosis, or presence of UTI before the BOTOX treatment with the persistence of incontinence. The median relapse time after the first two treatments was 6 (interquartile range = 5) and 10.5 months, respectively (P = 0.31). Significant improvements were recorded urodynamically in maximum cystometric capacity after each treatment (P < 0.001) and in maximum detrusor pressure after the first session compared to baseline (P < 0.05, Bonferonni correction). The presence of UTI did not affect the incontinence relapse time or urodynamic changes after initial treatment. Conclusions: In the present cohort, intravesical administration of 200U BOTOX achieved complete cure of neurogenic drug-resistant incontinence in a significant proportion of patients with sustained clinical and urodynamic changes after each repeat injection.