Original Article

Botulinum toxin in spinal cord injury patients with neurogenic detrusor overactivity


Young Sam Cho, Khae Hawn Kim

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Evidence for the efficacy and safety of intravesical onabotulinum toxin A (onabotA) injections has led to them being licensed in many coun-tries, including Korea, for the treatment of patients with urinary inconti-nence due to neurogenic detrusor overactivity (NDO) resulting from spinal cord injury or multiple sclerosis who are refractory or intolerant to anticholinergic medications. OnabotA injections have an inhibitory effect on acetylcholine release for up to 10 months, with a recommend-ed dose of 200 U. OnabotA treatment has a beneficial effect not only on urinary symptoms, but also on quality of life. Several clinical studies have shown onabotA to have better effects than placebo in achieving continence, reducing incontinence episodes, improving urodynamic parameters, and improving health-related quality of life. Urinary tract in-fections and postvoid residual volume are the most prevalent side ef-fects. In patients with residual volume, clean intermittent catheteriza-tion may be necessary. In patients with spinal cord injury or multiple sclerosis, it is recommended to evaluate physical and cognitive function before intravesical onabotA injection to ensure that the patient and caregiver are able to perform catheterization if necessary. Further con-trolled trials should assess the optimal dose, injection technique, long-term safety of repeated injections, and optimal timing of onabotA treat-ment in the treatment of NDO.


  Results of clinical and urodynamic studies
  Results of repeated injection treatments and long-term efficacy
  Improvements in urinary incontinence
  Reduction in AD
  Decrease in the use of anticholinergic medications
  Decrease in UTI
  Upper tract improvement
  QoL and patient satisfaction
  Adverse effects and complications


  • Young Sam Cho Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
  • Khae Hawn Kim Department of Urology, Gachon University Gil Medical Center, Gachon University School of Medicine, Incheon, Korea


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