AUA 2018: OnabotulinumtoxinA for Neurogenic Detrusor Overactivity Reduces Frequency and Severity of Autonomic Dysreflexia and Improves Quality of Life for Individuals with Spinal Cord Injury

San Francisco, CA (UroToday.com) This session had several presentations that addressed the urologic management of patients with spinal cord injury (SCI). Patients with SCI often have debilitating lower urinary tract symptoms, which can greatly impact their quality of life. In addition, they may also experience life-threatening autonomic dysreflexia (AD) in response to neurogenic detrusor overactivity (NDO). Prevention of AD in these patients is of utmost importance not only because of the serious health effects of AD, but also because of its impact on quality of life.  OnabotulinumtoxinA is an effective, minimally invasive treatment for neurogenic detrusor overactivity, but its role in the prevention of AD, and the effect of this on quality of life is not well defined. The authors aimed to evaluate the objective changes in AD during UDS and daily life, as well as the subjective improvement in the quality of life as related to incontinence and AD symptoms in patients with SCI who underwent onabotulinumtoxinA injection.

35 patients with SCI and AD underwent onabotulinumtoxinA injection of 200 units, using a trigone-sparing technique. Patients had a spinal cord injury level at or above T6. Baseline and post-treatment UDS was performed with blood pressure monitoring as well as 24-hour ambulatory BP monitoring. Questionnaires were used to evaluate the incontinence-related quality of life and AD-related quality of life before and after treatment. Outcomes were assessed pre-treatment and 1 month post-treatment.

There were significant improvements in both incontinence-related quality of life and AD-related quality of life after onabotulinumtoxinA injection. AD episodes decreased from approximately 15 to 10 per day on ambulatory BP monitoring. The number of patients with AD on UDS decreased from 35 to 22. Complications were reported in 27 patients, all of which were Clavien Dindo classification I or II.

OnabotulinumtoxinA for Neurogenic Detrusor Overactivity

Overall, this was a very interesting study that showed improved lower urinary tract function in patients with SCI after onabotulinumtoxinA injection of 200 units. Significant improvements were seen in presence of AD not only during UDS, but also during daily life. Along with this were improved quality of life as related to incontinence and AD. Interestingly, there was a significant reduction in asymptomatic AD, which may contribute to an improvement in overall health of SCI patients that has thus far been overlooked. OnabotulinumtoxinA injection should be considered in SCI patients with NDO and AD to improve quality of life not only in regards to incontinence but also to a reduction in AD.

Presented by: Matthias Walter, MD, PhD, FEBU, University of British Columbia
Co-Authors: Stephanie L. Kran, Mark Nigro, Lynn Stothers, Daniel Rapoport, Alex Kavanagh, Andrei V. Krassioukov, Vancouver, Canada

Written by:  Dena Moskowitz, MD; Female Pelvic Medicine and Reconstructive Surgery Fellow, Virginia Mason Medical Center; @demoskowitz at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA
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