Meta-analysis of botulinum toxin A detrusor injections in the treatment of neurogenic detrusor overactivity after spinal cord injury

Arch Phys Med Rehabil. 2013 Aug;94(8):1473-81. doi: 10.1016/j.apmr.2013.04.011. Epub 2013 Apr 28.

Abstract

Objective: To examine the effectiveness of botulinum toxin type A (BTX-A) on neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI).

Data sources: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to June 2012.

Study selection: Trials examining the use of BTX-A injections into the detrusor wall in the treatment of NDO after SCI were included if (1) ≥ 50% of study sample comprised subjects post-SCI; (2) outcomes of interest were assessed before and after treatment with a single injection of BTX-A; and (3) the sample size was ≥ 3.

Data extraction: A standardized mean difference ± SE (95% confidence interval) was calculated for at least 1 of the following outcomes in every study: postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, catheterization frequency, and maximum flow rate. Results from all studies were then pooled using a random-effects model. Treatment effect sizes were interpreted as small, >0.2; moderate, >0.5; or large, >0.8.

Data synthesis: Fourteen studies representing data from 734 subjects were included. After BTX-A injection, large treatment effects were observed in postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, and catheterization frequency (P<.01). Rate of incontinence episodes was reduced from 23% to 1.31% after BTX-A treatment. No significant decrease in max flow rate was observed (P=.403).

Conclusions: Results of the meta-analysis indicate BTX-A is effective in treating NDO after SCI. The use of BTX-A was associated with a decrease in incontinence episodes, catheter use, and bladder pressures.

Keywords: BTX-A; Botulinum toxins; NDO; PRV; QOL; Rehabilitation; SCI; Spinal cord injuries; UTI; Urinary bladder; botulinum toxin type A; neurogenic detrusor overactivity; postresidual urine volume; quality of life; spinal cord injury; urinary tract infection.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Botulinum Toxins, Type A / administration & dosage*
  • Humans
  • Injections, Intramuscular
  • Neuromuscular Agents / administration & dosage*
  • Recovery of Function
  • Spinal Cord Injuries / complications*
  • Treatment Outcome
  • Urinary Bladder, Neurogenic / drug therapy*
  • Urinary Bladder, Neurogenic / etiology
  • Urinary Bladder, Overactive / drug therapy*
  • Urinary Bladder, Overactive / etiology

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A