Results after the botulinum toxin type A injection in a neurogenic bladder in patients with spinal chord injury
Keywords:
Myeloningocele, Chiari malformation, functional level, neurologic complications.Abstract
Introduction: Neurogenic bladder is a bladder dysfunction derived from a disorder or neurological injury. Bladder spasticity after spinal cord injury develops on patients with suprasacral injuries after spinal shock is over. Bladder dysfunction can cause autonomic dysreflexia leading to a medical emergency. Treatment objectives are to obtain regular emptying of the bladder, to avoid the increase in emptying and filling pressure, maintain continence, and to prevent complications such as urinary tract infections, calculi, stenosis, and autonomic dysreflexia. This studies’ objective is to determine the efficiency of botulinum toxin type A injection,
in patients with spinal cord injury.
Materials and methods: Quasi-experimental study, pre-post. 7 patients (6 males, 1 female) with spinal cord injuries ASIA A, neurogenic bladder. Average age: 36 years old. 300UI botulinum toxin type A injection, applied in the detrusor muscle through a cystoscopy procedure.
Results: Prior to the botulinum toxin type A injection, bladder capacity in 100% of patients was low, all were on anticholinergic treatment and presented uninhibited bladder contractions, with a magnitude average of 72,85 cm of water. Average compliance rate was 5,94 cm of water. All patients presented urinary incontinence, 85,7% severe (wearing more than 2 diapers a day). 29% of patients presented dysreflexic crisis daily. Urodynamic study after the injection of the botulinum toxin type A check was performed, on average, around the 13th week. Posterior to the botulinum toxin type A injection, bladder capacity continued low only in 14% of the patients, in 57% it was normal and in 29 % it was high, 57%
continued on anticholinegic medication. Only 14,3% persisted with uninhibited bladder contractions with a magnitude of 60
cm of water. Average compliance rate was 22,05 cm of water.
Urine incontinence decreased to 57.15% (66% low-34% severe). Dysreflexic crisis persisted but frequency became normal.
Conclusion: We may conclude that the injection of botulinum toxin type A, constitutes an efficient and safe treatment for the neurogenic hiperreflexic bladder, improving its capacity, decreasing the urine leakage between catheterizations, and a decrease in the need for diapers (decreasing costs), giving the patient a feeling of security, and giving him an improved quality of life.
Author Biographies
Melina Longoni, Centro Integral de Rehabilitación APREPA, San Jerónimo Sur
Juan Carlos Contardi, Centro Integral de Rehabilitación APREPA, San Jerónimo Sur.
Horacio Damiani, Centro Integral de Rehabilitación APREPA, San Jerónimo Sur.
José Luis Fadil Iturralde, Sanatorio de niños, servicio de urología.
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