Intravesical botulinum toxin A (BoTA) has significantly changed the treatment landscape for patients with neurogenic bladder. Prior to its FDA approval in 2011, treatment options were limited to patients failing medical management, often requiring invasive surgical interventions such as augmentation cystoplasty to promote continence and preserve renal function. While more research is needed to better understand long-term efficacy and differences in utilization patterns between providers, randomized controlled trials and our daily practice has demonstrated significant improvements incontinence, bladder mechanics, and quality of life following intravesical BoTA administration. Significant advantages include: (1) ease of administration (short, outpatient procedure), (2) safety and side effect profile, (3) patient compliance (does not require a daily dose of pharmacotherapy), (4) cost-effectiveness, (5) patient satisfaction, and (6) durable efficacy. Special care should always be taken in this population to ensure whether or not he/she is receiving BoTA injections for other purposes including muscle contractures (not uncommon in the neurogenic population) and thus be aware of the need to coordinate the timing of injections and monitor total dose administered. The patient’s history and risk of autonomic dysreflexia should also be assessed prior to in-office treatment, and management should be immediately available if needed. Overall, the goal of this review is to share the indications, technique, and efficacy of intravesical BoTA with other specialties, specifically physiatrists, who care for patients with neurogenic bladder.
Written by: Lauren Folgosa Cooley, MD, PhD1, Stephanie Kielb, MD1
1. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL