Treating Neurogenic Lower Urinary Tract Dysfunction in Chronic Spinal Cord Injury Patients—When Intravesical Botox Injection or Urethral Botox Injection Are Indicated

Toxins, 2023 · DOI: 10.3390/toxins15040288 · Published: April 17, 2023

Simple Explanation

Lower urinary tract symptoms (LUTS) negatively impact the quality of life for individuals with spinal cord injury (SCI). These symptoms include urgency, urinary incontinence, and difficulty voiding. Botulinum toxin A (BoNT-A) injections into the bladder muscle or urethral sphincter can help manage urinary incontinence or improve bladder emptying. However, these injections also have potential side effects. This paper reviews the use of BoNT-A injections for lower urinary tract problems in SCI patients, covering both the benefits and drawbacks of this treatment option.

Study Duration

Not specified

Participants

SCI patients with neurogenic lower urinary tract dysfunction

Evidence Level

Review

Key Findings

1
Detrusor BoNT-A injection can decrease daily incontinence episodes, the frequency of clean intermittent catheterization (CIC), and maximal detrusor pressure while increasing cystometric bladder capacity and reflux volume.
2
Combining BoNT-A detrusor and urethral sphincter injections might reduce both detrusor and urethral pressure without increasing postvoid residual volume (PVR), daily CIC frequency, or daily pad use.
3
Adherence to detrusor BoNT-A injections in SCI patients is associated with better treatment outcomes and greater patient satisfaction. Repeated injections help maintain favorable effects.

Research Summary

This review summarizes the application of botulinum toxin A (BoNT-A) injections for managing lower urinary tract symptoms (LUTS) in spinal cord injury (SCI) patients, addressing both therapeutic efficacy and potential adverse events. BoNT-A detrusor injections improve bladder compliance and urinary continence but often require clean intermittent catheterization (CIC) due to impaired detrusor contractility. Urethral sphincter injections improve bladder emptying but may worsen urinary incontinence. The review emphasizes the need for individualized treatment strategies, considering factors such as the level and severity of SCI, patient dexterity, bladder pressure, and upper urinary tract condition to optimize outcomes with BoNT-A therapy.

Practical Implications

Personalized Treatment

Tailor BoNT-A injection strategies based on individual patient characteristics, including SCI level, symptoms, and bladder function, to optimize treatment outcomes.

Weighing Benefits and Risks

Carefully consider the potential benefits and risks of BoNT-A injections, including adverse events and the need for CIC, to make informed treatment decisions.

Long-term Management

Implement long-term monitoring and regular urodynamic evaluations to adjust BoNT-A dosage and injection timing, ensuring sustained therapeutic efficacy and patient satisfaction.

Treating Neurogenic Lower Urinary Tract Dysfunction in Chronic Spinal Cord Injury Patients—When Intravesical Botox Injection or Urethral Botox Injection Are Indicated

Simple Explanation

Key Findings

Research Summary

Practical Implications

Personalized Treatment

Weighing Benefits and Risks

Long-term Management

Study Limitations

Your Feedback

Was this summary helpful?

Treating Neurogenic Lower Urinary Tract Dysfunction in Chronic Spinal Cord Injury Patients—When Intravesical Botox Injection or Urethral Botox Injection Are Indicated

Simple Explanation

Key Findings

Research Summary

Practical Implications

Personalized Treatment

Weighing Benefits and Risks

Long-term Management

Study Limitations

Your Feedback

Was this summary helpful?