Clinical effectiveness of intradetrusor injections of botulinum toxin type a in dose 100 units in multiple sclerosis patients with neurogenic detrusor overactivity

Intravesical injections of botunulinum toxin type A (BTA) demonstrate good results in treatment of detrusor overactivity symptoms in patients with neurogenic low urinary tract dysfunction (NLUTD) when use in recommended doses of 200 and 300 Units. In clinical practice a government insurance dose not cover the price for the 200 BTA Units and only 100 Units may be injected in patients with neurogenic and nonneurogenic detrusor overactivity. The aim was to evaluate the efficiency of intradetrusor injections of BTA in patients with NLUTD. Materials and methods. The study included 28 MS patients with resistant to medical treatment neurogenic detrusor overactivity. All patients received intradetrusor injections of 100 BTA Units. The results were assessed after 1, 3 and 6 months after procedure. Results. Clinical improvement had been achieved in all 28 patients. According to the urodynamic studies three months after BTA injections maximal cystometric capacity increased by 119.9 37.6% (p 0,05), volume at first detrusor involuntary contraction increased by 74.8 21.4% (p 0,05), maximal detrusor pressure at involuntary contraction decreased by 53.5 29.7% (p 0,05). The NBSS total score decreased from 38.04 14.27 to 29.06 14.46 (p = 0,000), mainly because of questions about incontinence and urgency. SF-Qualiveen total score turned from 2.32 0.70 to 1.61 0.85 (p = 0.000). Before procedure 2 patients performed intermittent catheterization, 4 patients catheterized after BTA injections. Conclusion. Intradetrusor injection of 100 BTA Units in MS patients with NLUTD resulted in improvement of urodynamic parameters followed by reduction of clinical symptoms and life quality improvement for 6 months of observation. Using of BTA low dose didnt provide a total abortion of neurogenic detrusor overactivity symptoms but led to the starting of IC only in 2 patients.