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  4. Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

Spinal Cord, 2016 · DOI: 10.1038/sc.2015.143 · Published: August 11, 2015

Spinal Cord InjuryUrologyNeurology

Simple Explanation

This study investigated whether injecting botulinum toxin A (BTX-A) into both the detrusor muscle and the trigone area of the bladder is more effective than injecting it only into the detrusor muscle for treating urinary incontinence caused by neurogenic detrusor overactivity (NDO). The study compared two groups of patients with spinal cord injuries and urinary incontinence due to NDO: one group received BTX-A injections in the detrusor muscle excluding the trigone, and the other group received injections in both the detrusor muscle and the trigone. The results showed that the group receiving injections in both areas experienced greater improvements in incontinence-related quality of life, fewer incontinence episodes, increased voiding volume, and reduced bladder pressure.

Study Duration
3 years (June 2011 to June 2014)
Participants
96 spinal cord injury patients
Evidence Level
Level 1, prospective, multicenter, single-blind, randomized controlled trial

Key Findings

  • 1
    BTX-A injections into both the detrusor and trigone muscles resulted in significantly better improvements in I-QoL compared to detrusor-only injections at 12 weeks post-injection.
  • 2
    Patients receiving combined injections experienced a significant reduction in urinary incontinence episodes compared to the control group.
  • 3
    The study found no cases of vesicoureteral reflux (VUR) in either group, suggesting that intratrigonal injections of BTX-A do not induce VUR.

Research Summary

This study evaluated the effectiveness and safety of combined detrusor-trigone BTX-A injections for treating urinary incontinence secondary to neurogenic detrusor overactivity (NDO) in spinal cord injury patients. The results indicated that combined injections are more effective than detrusor-only injections in improving incontinence-specific quality of life, reducing urinary incontinence episodes, and improving urodynamic parameters. The study also confirmed that intratrigonal injections of BTX-A do not induce vesicoureteral reflux (VUR), suggesting that this approach is safe.

Practical Implications

Clinical Practice

Combined detrusor-trigone BTX-A injections may be considered as a more effective treatment option for patients with NDO and urinary incontinence compared to detrusor-only injections.

Patient Outcomes

Patients may experience improved quality of life, reduced incontinence episodes, and better bladder control with the combined injection approach.

Safety Profile

The study supports the safety of intratrigonal BTX-A injections, as no cases of VUR were observed.

Study Limitations

  • 1
    Relatively small sample size
  • 2
    Short follow-up period (12 weeks)
  • 3
    Not specified

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