Therapeutic effects of suburothelial injection of botulinum a toxin for neurogenic detrusor overactivity due to chronic cerebrovascular accident and spinal cord lesions

Objectives. To investigate the therapeutic effects of suburothelial botulinum A toxin for patients with chronic cerebrovascular accident (CVA) and spinal cord lesions. Suburothelial injection of botulinum A toxin can effectively inhibit the occurrence of neurogenic detrusor overactivity. Methods. Twenty-four patients with neurogenic detrusor overactivity refractory to anticholinergics were enrolled and treated with 200 U of botulinum A toxin injected into the suburothelial space. The clinical effects on the lower urinary tract symptoms and urodynamic parameters were assessed. Results. Of the 24 patients enrolled in the study, 12 had CVA and 12 had suprasacral cord lesions (SCLs). After treatment, the volume of the first involuntary detrusor contraction and bladder capacity increased twofold and the postvoid residual volume fourfold for both patient groups after 1 month, decreasing slightly at 3 months. The detrusor pressure for the SCL group decreased significantly after treatment (39.1 +/- 16.6 versus 21.2 +/- 14.1, P=0.002) relative to the CVA patients. Complete continence and improvement of incontinence grade were achieved in 1 (8.3%) and 5 (41.7%) patients with CVA and in 4 (33.3%) and 7 (58.3%) patients with SCLs. However, patients in both groups experienced an increase in voiding difficulty after treatment. The therapeutic effect declined gradually after 3 months, and all patients had experienced symptom relapse by 6 months. Conclusions. Suburothelial botulinum A toxin at a dose of 200 U increased bladder capacity and improved the incontinence grade in 91.6% of the patients with SCL, but this was achieved for only 50% of the patients with CVA.