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World Journal of Urology

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01-06-2009 | Original Article

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

Authors: Ulrich Mehnert, Sönke Boy, Marius Schmid, André Reitz, Alexander von Hessling, Juerg Hodler, Brigitte Schurch

Published in: World Journal of Urology | Issue 3/2009

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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Title: A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging
Authors: Ulrich Mehnert
Sönke Boy
Marius Schmid
André Reitz
Alexander von Hessling
Juerg Hodler
Brigitte Schurch
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: World Journal of Urology / Issue 3/2009
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-008-0362-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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