Treatment of neurogenic detrusor overactivity and overactive bladder with Botox (onabotulinumtoxinA): Development, insights, and impact

This article discusses the use of onabotulinumtoxinA (Botox) for treating neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). NDO is caused by neurological conditions like spinal cord injury or multiple sclerosis, while OAB is not caused by an obvious neurological condition. Both conditions lead to urinary incontinence and negatively impact quality of life. Before Botox, treatments included oral anticholinergics and surgery. Botox was approved for NDO in 2011 and OAB in 2013 after clinical trials showed it significantly reduced urinary incontinence episodes and improved quality of life. Common side effects included urinary tract infections and urinary retention. Long-term studies have demonstrated that repeat injections of onabotulinumtoxinA maintain effectiveness and safety for both NDO and OAB. The use of onabotulinumtoxinA has profoundly improved the QOL of patients failing anticholinergic therapy and has expanded the utilization of onabotulinumtoxinA into smooth muscle.

• 1
  OnabotulinumtoxinA (Botox) significantly reduces urinary incontinence episodes in patients with NDO and OAB compared to placebo.
• 2
  Treatment with onabotulinumtoxinA leads to significant improvements in urodynamic parameters, such as increased maximum cystometric capacity and decreased maximum detrusor pressure during involuntary detrusor contractions.
• 3
  OnabotulinumtoxinA treatment results in substantial improvements in patients' quality of life, as measured by various QOL questionnaires and patient satisfaction scores.