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Leilaz A, Joussain C, Denys P, Bensmail D, Levy J. Concomitant Botulinum Toxin Injections for Neurogenic Detrusor Overactivity and Spasticity-A Retrospective Analysis of Practice and Safety. Toxins (Basel) 2024; 16:252. [PMID: 38922146 PMCID: PMC11209118 DOI: 10.3390/toxins16060252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
As multiple indications for botulinum toxin injections (BTIs) can coexist for neurological patients, there are to date no description of concomitant injections (CIs) to treat both spasticity and neurogenic detrusor overactivity incontinence (NDOI) in patients with spinal cord injuries (SCIs) and multiple sclerosis (MS). We therefore identified patients followed at our institution by health data hub digging, using a specific procedure coding system in use in France, who have been treated at least once with detrusor and skeletal muscle BTIs within the same 1-month period, over the past 5 years (2017-2021). We analyzed 72 patients representing 319 CIs. Fifty (69%) were male, and the patients were mostly SCI (76%) and MS (18%) patients and were treated by a mean number of CIs of 4.4 ± 3.6 [1-14]. The mean cumulative dose was 442.1 ± 98.8 U, and 95% of CIs were performed within a 72 h timeframe. Among all CIs, five patients had symptoms evocative of distant spread but only one had a confirmed pathological jitter in single-fiber EMG. Eleven discontinued CIs for surgical alternatives: enterocystoplasty (five), tenotomy (three), intrathecal baclofen (two) and neurotomy (one). Concomitant BTIs for treating both spasticity and NDOI at the same time appeared safe when performed within a short delay and in compliance with actual knowledge for maximum doses.
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Affiliation(s)
- Arnaud Leilaz
- Spinal Unit, Department of Physical and Rehabilitation Medicine, Raymond Poincaré Teaching Hospital, APHP Paris Saclay, 92380 Garches, France; (A.L.); (D.B.)
- School of Medicine, Sorbonne University, 75013 Paris, France
| | - Charles Joussain
- Neurourology Unit, Department of Physical and Rehabilitation Medicine, Raymond Poincaré Teaching Hospital, APHP Paris Saclay, 92380 Garches, France; (C.J.); (P.D.)
- INSERM 1179, University of Versailles Saint-Quentin-en-Yvcelines, 78180 Montigny-le-Bretonneux, France
| | - Pierre Denys
- Neurourology Unit, Department of Physical and Rehabilitation Medicine, Raymond Poincaré Teaching Hospital, APHP Paris Saclay, 92380 Garches, France; (C.J.); (P.D.)
- INSERM 1179, University of Versailles Saint-Quentin-en-Yvcelines, 78180 Montigny-le-Bretonneux, France
| | - Djamel Bensmail
- Spinal Unit, Department of Physical and Rehabilitation Medicine, Raymond Poincaré Teaching Hospital, APHP Paris Saclay, 92380 Garches, France; (A.L.); (D.B.)
- INSERM 1179, University of Versailles Saint-Quentin-en-Yvcelines, 78180 Montigny-le-Bretonneux, France
| | - Jonathan Levy
- Spinal Unit, Department of Physical and Rehabilitation Medicine, Raymond Poincaré Teaching Hospital, APHP Paris Saclay, 92380 Garches, France; (A.L.); (D.B.)
- INSERM 1179, University of Versailles Saint-Quentin-en-Yvcelines, 78180 Montigny-le-Bretonneux, France
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Wada N, Ishikawa M, Nagabuchi M, Makino S, Miyauchi K, Abe N, Kakizaki H. Deterioration of bladder compliance after botulinum toxin A injection and discontinuation of medication for overactive bladder. IJU Case Rep 2022; 5:384-388. [PMID: 36090943 PMCID: PMC9436694 DOI: 10.1002/iju5.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction We report a case of deterioration of bladder compliance after botulinum toxin type A injection and discontinuation of medication for overactive bladder. Case presentation A female patient with overactive bladder in her sixties had been visiting our outpatient clinic regularly for 4 years. She had received posterolateral spondylus fusion twice, which resulted in a compression fracture. She had been receiving a combination therapy of anticholinergics and β3‐adrenoceptor agonist for the management of overactive bladder. She received botulinum toxin type A injection for refractory overactive bladder and discontinued medical treatment for overactive bladder. Three months after botulinum toxin type A injection, cystometry revealed the deterioration of bladder compliance. Renal dysfunction, hydronephrosis, and vesicoureteral reflux were shown. Renal function and hydronephrosis were improved after restarting anticholinergics and β3‐adrenoceptor agonist therapy and inserting a temporary transurethral catheter. Conclusion Deterioration of bladder compliance may occur after botulinum toxin type A injection and discontinuation of overactive bladder medication in some patients with underlying neurological disease.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Mayumi Ishikawa
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Masaya Nagabuchi
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Shogo Makino
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Noriyuki Abe
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery Asahikawa Medical University Asahikawa Japan
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Kuo HC. Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do? Toxins (Basel) 2022; 14:toxins14070498. [PMID: 35878235 PMCID: PMC9324011 DOI: 10.3390/toxins14070498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
Botulinum toxin A (Botox) had been considered a promising drug that has an effect on functional disorders of the lower urinary tract. Because Botox exhibits anti-inflammatory and antispasmodic effects, Botox injection into the bladder can decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations. Injecting Botox into the bladder outlet can relax the hyperactivity of the bladder neck, and of the urethral smooth and striated muscles. Based on these therapeutic effects, Botox has been widely applied to treat lower-urinary-tract dysfunctions (LUTDs) such as overactive bladder and neurogenic detrusor overactivity. However, this treatment has not been licensed for use in other LUTDs such as interstitial cystitis, voiding dysfunction due to benign prostatic hyperplasia in men, and dysfunctional voiding in women. Botox has also not been approved for the treatment of children with overactive bladder and dysfunctional voiding; in patients with spinal cord injuries with detrusor sphincter dyssynergia and autonomic dysreflexia; or for poorly relaxed external sphincter in non-neurogenic patients. This article reviews the current knowledge regarding Botox treatment for LUTDs and discusses the potential clinical applications of Botox, as well as work that can be conducted in the future.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 97004, Taiwan
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Blé O, Levy J, Lefèvre C, Perrouin-Verbe MA, Even A, Le Normand L, Kastler EC, Perrouin-Verbe B, Denys P, Joussain C. Neurogenic bladder in patients with paraplegia: a two-center study of the real-life experience of the patients' journey. World J Urol 2022; 40:1743-1749. [PMID: 35648199 DOI: 10.1007/s00345-022-04044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Several patterns of urological dysfunctions have been described following spinal cord injury (SCI), depending on the level and the completeness of the injury. A better understanding of the natural history of neurogenic bladder in patients with SCI, and the description of their successive therapeutic lines based on their clinical and urodynamic pattern is needed to improve their management. This study aimed to describe the real-life successive therapeutic lines in patients with neurogenic lower urinary tract dysfunction (NLUTD) following SCI. METHODS We conducted a two-center retrospective review of medical files of patients with SCI followed in two French specialized departments of Physical Medicine and Rehabilitation between January 2000 and January 2018. All patients with SCI with a level of lesion bellow T3 and older than 18 years old were eligible. The primary outcome was the description of the natural journey of neurogenic bladder in this population, from the awakening bladder contraction to the last therapeutic line. Survival curves were calculated with a 95-confidence interval using the Kaplan-Meier method. RESULTS One hundred and five patients were included in this study. Most of the patients were young men with a complete SCI lesion. The median time of treatment introduction was 1 and 9 years for anticholinergics and intradetrusor injection of BoNT/A, respectively. Median duration of effect of treatments was 4 and 6 years post-introduction of anticholinergics and BoNT/A, respectively. CONCLUSION This study describes NLUTD journey of patients with SCI demonstrating the mid-term efficacy of the two first therapeutic lines of NDO management. An improvement of non-surgical therapeutics is needed.
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Affiliation(s)
- O Blé
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
| | - J Levy
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France
| | - C Lefèvre
- Department of Neurological Physical Medicine and Rehabilitation, Saint-Jacques Hospital, Nantes University Hospital, Nantes, France
| | | | - A Even
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
| | - L Le Normand
- Department of Urology, Nantes University Hospital, Nantes, France
| | - E Chartier Kastler
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Saint-Jacques Hospital, Nantes University Hospital, Nantes, France
| | - P Denys
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France
| | - C Joussain
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France.
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France.
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