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A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

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Abstract

Objectives

Although botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscarinic drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. Therefore, we investigated the distribution of the toxin solution after injection into the bladder wall, using magnet resonance imaging (MRI).

Methods

Six patients with NDO were recruited. Three of six patients received 300 U of BoNT/A + contrast agent distributed over 30 injection sites (group 1). The other three patients received 300 U of BoNT/A + contrast agent distributed over 10 injection sites (group 2). Immediately after injection, MRI of the pelvis was performed. The volume of the detrusor and the total volume of contrast medium inside and outside the bladder wall were calculated.

Results

In all patients, a small volume (mean 17.6%) was found at the lateral aspects of the bladder dome in the extraperitoneal fat tissue, whereas 82.4% of the injected volume reached the target area (detrusor).

In both groups there was a similar distribution of the contrast medium in the target area. A mean of 33.3 and 25.3% of the total detrusor volume was covered in group 1 and 2, respectively. Six weeks after injection, five of six patients were continent and showed no detrusor overactivity in the urodynamic follow-up. No systemic side effects were observed.

Conclusions

Our results provide morphological arguments that the currently used injection techniques are appropriate and safe.

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Acknowledgments

This Study was funded by the Swiss National Science Foundation (SNF Project 320000-113644, Urodynamical and electrophysiological assessment of normal and impaired human bladder function).

Conflict of interest statement

Brigitte Schurch is a consultant for Allergan.

Author information

Authors and Affiliations

  1. Neurourology, Spinal Cord Injury Center, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    Ulrich Mehnert, Sönke Boy, André Reitz & Brigitte Schurch

  2. Department of Radiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    Marius Schmid & Juerg Hodler

  3. Department of Radiology, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9000, St. Gallen, Switzerland

    Alexander von Hessling

Authors
  1. Ulrich Mehnert
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  2. Sönke Boy
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  4. André Reitz
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  5. Alexander von Hessling
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  6. Juerg Hodler
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  7. Brigitte Schurch
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Correspondence to Ulrich Mehnert.

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Mehnert, U., Boy, S., Schmid, M. et al. A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging. World J Urol 27, 397–403 (2009). https://doi.org/10.1007/s00345-008-0362-0

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  • DOI: https://doi.org/10.1007/s00345-008-0362-0

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