Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience
urinary incontinence with or without difficult urination, which might promote recurrent
urinary tract infection (UTI) and exacerbate upper urinary tract function. Nonetheless, appropriate bladder management has been shown to reduce urological complications and improve quality of life. In addition to pharmacological
therapy and surgical intervention,
botulinum toxin A (
BoNT-A) has been widely utilized in NLUTD. The therapeutic efficacy of detrusor
BoNT-A injections for neurogenic detrusor overactivity due to
spinal cord injury (SCI),
multiple sclerosis, or other central nervous system lesions, such as
cerebrovascular accident,
Parkinson disease, early
dementia, and pediatric NLUTD due to
myelomeningocele, has been well established, with repeated
BoNT-A injections every 6 to 9 months being necessary to maintain its
therapeutic effects. Urethral
BoNT-A injection can decrease urethral sphincter resistance and facilitate efficient voiding in patients with NLUTD who wish to preserve self-voiding. Detrusor
BoNT-A injection can also decrease the occurrence of
autonomic dysreflexia in patients with SCI, even after failed augmentation enterocystoplasty, with additional benefits including reduced UTI episodes and preserved renal function with repeated
injections. However, this treatment does have some side effects. Complete informed consent for
BoNT-A injection
therapy with full disclosure of its potential complications should therefore be obtained before this procedure is undertaken.