14th Congress of the European Federation of Neurological Societies
Webcasted Presentation

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Neuro-urological disorders and botulinum A toxin
Assoc. Prof. Antonella Giannantoni
Assoc. Prof. Antonella Giannantoni
Perugia, Italy  
Disclosure: I am consultant for Allergan SpA, Irvine USA
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Topic: Other
36 slide(s) – 00:26:20– English –2010-09-27
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- know the rationale of using botulinum A toxin in treating neurogenic voiding dysfunction

- know the mechanisms of action of botulinum A toxin into the detrusor muscle

- know the clinical evidence on the treatment of neurogenic bladder with botulinum A toxin

- know the clinical and urodynamic effects and side effects of the treatment

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Over the past decade, the use of botulinum neurotoxin type A (BoNTA) has been introduced in urology as the treatment of refractory overactive bladder syndrome of both neurogenic and non-neurogenic origin, benign prostatic hyperplasia and pelvic pain syndrome. In neurogenic detrusor overactivity (NDO) the post-treatment reductions in detrusor pressures during both phasic involuntary contractions and on voiding are evidence for an effect of BoNTA on the motor innervation of the detrusor, although the neurologic deficit which additionally affects voiding efficiency in the NDO group may partly explain the high rate of post-treatment clean intermittent self-catheterizations. The majority of treated patients with neurogenic bladder has spinal NDO due to spinal cord injury or multiple sclerosis. The obtained results show that Botox 300 U is the most commonly used dosage. Almost all single-injection studies show significant improvements at the last follow-up in incontinence episodes, maximum cystometric capacity and maximum detrusor pressure. The mean percentage of spinal patients who become fully continent is about 55% (range: 30-87%).Also patients with Parkinson’s disease and Multiple System Atrophy have been recently treated with BoNT/A intradetrusorial injections, with short-term satisfactory results. Quality of life improves independent of questionnaire used and also in placebo-controlled trials. Patients may undergo repeated injections along time, and no bladder fibrosis has been documented in histological studies. No consistent systemic side effects have been described after the injections. Local toxicity may be represented by transient bleeding, bladder oedema and urinary tract infection after the surgical procedure.
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