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Are 200 units of onabotulinumtoxin A sufficient for the suppression of neurogenic detrusor overactivity in individuals with established 300-unit botulinum toxin treatment? A retrospective cohort study

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Abstract

Study design

Retrospective cohort study.

Objectives

To investigate the effects of 200-unit onabotulinumtoxin A detrusor injections on neurogenic detrusor overactivity (NDO) in patients who have previously been treated with 300-unit injections.

Setting

Tertiary urologic referral center in Switzerland.

Methods

The patient database was screened for patients with NDO as a result of chronic (≥ 12 months) spinal cord injury (SCI), who had been treated with 300- followed by 200-unit onabotulinumtoxin A detrusor injections. Patient characteristics, bladder management data and concurrent bladder medication as well as urodynamic data were collected. The percent changes in the urodynamic parameters from the 300- to the 200-unit treatment phase were calculated to test for non-inferiority of the 200-unit treatment.

Results

The data of 61 individuals with a mean age of 44 ± 15 years (range 18–73 years) and a mean 13.2 ± 9.5 years (range 2–43 years) since SCI were analyzed. The 200-unit treatment was not inferior regarding the urodynamic parameters compared to the 300-unit treatment. Furthermore, the proportion of patients with urinary incontinence was similar for both doses. There was no significant difference in the number of daily bladder evacuations (p = 0.13) or used incontinence pads (p = 0.43) between the two dosage phases. Moreover, there was no significant (p = 0.19) increase in the use of concurrent NDO medication (antimuscarinics or mirabegron) during the 200-unit treatment.

Conclusions

The treatment of NDO with 200 units of onabotulinumtoxin A was not inferior to a 300-unit treatment regarding urodynamic parameters in patients with chronic SCI.

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Data archiving

The data analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

We have received no external funding.

Author information

Authors and Affiliations

  1. Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland

    Jörg Krebs

  2. Neuro-Urology, Swiss Paraplegic Centre, Guido A. Zäch Str. 1, 6207, Nottwil, Switzerland

    Jürgen Pannek, Franziska Rademacher & Jens Wöllner

  3. Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Jürgen Pannek

Authors
  1. Jörg Krebs
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  2. Jürgen Pannek
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  3. Franziska Rademacher
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  4. Jens Wöllner
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Contributions

JK: analysis and interpretation of data, writing of the manuscript, approval of final version. JP: project development, interpretation of data, editing of the manuscript, approval of final version. FR: acquisition of data, editing of the manuscript, approval of final version. JW: project development, interpretation of data, editing of the manuscript, approval of final version.

Corresponding author

Correspondence to Jürgen Pannek.

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Conflict of interest

The authors declare no conflict of interest.

Ethics statement

This study had been approved by the competent ethics committee (2017–02257) and all applicable institutional and governmental regulations concerning the ethical use of the data were followed. All data were encrypted and kept confidential.

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Krebs, J., Pannek, J., Rademacher, F. et al. Are 200 units of onabotulinumtoxin A sufficient for the suppression of neurogenic detrusor overactivity in individuals with established 300-unit botulinum toxin treatment? A retrospective cohort study. World J Urol 39, 543–547 (2021). https://doi.org/10.1007/s00345-020-03211-1

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  • DOI: https://doi.org/10.1007/s00345-020-03211-1

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