Page 1 - Canadian Journal of Urology
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HOW I DO IT
© The Canadian Journal of Urology™; 20(1); February 2013
Accepted for publication November 2012
A video is available online at
Address correspondence to Dr. Patrick J. Shenot, Department
of Urology, Thomas Jefferson University, 1025Walnut Street,
Suite 1112, Philadelphia, PA 19107 USA
Intradetrusor onabotulinumtoxinA injection:
how I do it
Patrick J. Shenot, MD, J. Ryan Mark, MD
Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
SHENOT P J , MARK J R . I n t r a d e t r u s o r
onabotulinumtoxinA injection: how I do it.
Can J Urol
2013;20(1):6649-6655.
Overactive bladder is a highly prevalent condition that may
have significant impact on quality of life. This condition
may be idiopathic or may have a neurogenic etiology.
Antimuscarinics have long been the preferred agents for
the treatment of this condition. OnabotulinumtoxinA,
an injectible agent that prevents presynaptic release of
acetylcholine at the neuromuscular junction, has emerged
as an important option in the management of patients
with urinary incontinence caused by refractory detrusor
overactivity. This manuscript describes our technique for
performing utilizing this therapy, describes key equipment
needed and provides technical tips for avoiding common
pitfalls.
KeyWords:
overactivebladder, urinary incontinence,
onabotulinumtoxinA
The management of neurogenic overactive bladder
(NOAB) can be challenging for both the patient and
the physician. Management options for NOAB
are usually aimed at protecting the upper urinary
tract (elevated bladder storage pressures secondary
to decreased bladder compliance and/or high
pressure detrusor overactivity) and managing lower
urinary tract symptoms. Treatments options may
include behavioral changes, anticholinergic therapy,
neuromodulation, intermittent catheterization,
external or indwelling catheters, augmentation
cystoplasty, and urinary diversion.
Anticholinergicmedications canprovidemeasurable
relief of symptoms in some patients, however these
medications produce many undesirable side effects
and are often not well tolerated. Intradetrusor
injection of onabotulinumtoxinA (BOTOX, Allergan
Inc. Irvine, CA, USA) has emerged as a safe and
effective treatment for urinary incontinence and
recently received FDAapproval for use in patients with
NDO.
6649
Introduction
Patients with underlying neurologic disorders develop
significant lower urinary tract dysfunction. These
patients may present clinicallywith overactive bladder
(OAB), a highly prevalent symptom complex of
urinary urgency and frequency, with or without urge
incontinence.
1
These lower urinary tract symptoms in
patients with a known neurologic cause are frequently
referred to as neurogenic overactive bladder (NOAB).
Similarly, when the urodynamic observation of
detrusor overactivity (DO) is caused by a particular
neurologic condition, it is referred to as neurogenic
detrusor overactivity (NDO).
