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

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

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1
Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada.

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

PMID:
23632286
DOI:
10.1016/j.apmr.2013.04.011
[Indexed for MEDLINE]
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