Made Substantial contributions to conception and design.
Original Clinical Article
Article first published online: 3 OCT 2007
Copyright © 2007 Wiley-Liss, Inc.
Neurourology and Urodynamics
Volume 27, Issue 4, pages 311–314, April 2008
How to Cite
Mascarenhas, F., Cocuzza, M., Gomes, C. M. and Leão, N. (2008), Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients. Neurourol. Urodyn., 27: 311–314. doi: 10.1002/nau.20515
No conflict of interest reported by the author(s).
Dirk De Ridder led the review process.
- Issue published online: 9 APR 2008
- Article first published online: 3 OCT 2007
- Manuscript Accepted: 17 AUG 2007
- Manuscript Received: 6 MAY 2007
- botulinum toxin;
- detrusor overactivity;
- vesicoureteral reflux
We evaluated the effect of botulinum toxin type A (BTX-A) injections in the trigone on the antireflux mechanism and evaluated its short-term efficacy.
Materials and Methods
Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX-A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics.
At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX-A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271±92 to 390±189 ml (p=0.002), reflex volume varied from 241±96 to 323±201 ml (p=0.020) and maximum detrusor pressure reduced from 66±39 to 38±37 cm H2O (p<0.001).
Our results confirm the safety of trigone injections of BTX-A in terms of development of VUR and upper urinary tract damage. Whether they are beneficial for patients with NDO or other causes of voiding dysfunction will need further studies. Neurourol. Urodynam. 27:311–314, 2008. © 2007 Wiley-Liss, Inc.