Botulinum toxin type A injections in the augmented bladder after failure of augmentation enterocystoplasty in neurological patients: a retrospective multicenter study

Ms Carine CICERONa, Dr Benjamin BERNUZb, Prof Gilles KARSENTYc, Prof Alain RUFFIONd, Dr Alexia EVEN SCHNEIDERe, Dr Véronique FORINf, Prof Xavier GAMÉg, Prof Christian SAUSSINEh, Dr Andrea MANUNTAi, Dr Véronique KEPENNEj, Prof Philippe GRISEk

a hôpital Renée Sabran, CHU de Lyon, b hôpital Léon Bérard, Hyères, c hôpital La Conception, CHU de Marseille, d Centre Hospitalier Lyon Sud, CHU de Lyon, e Hôpital Raymond Poincaré, f Hôpital Armand Trousseau, g Hôpital Rangueil, CHU Toulouse, h CHU de Strasbourg, i CHRU Pontchaillou, Rennes, j CHR de Huy, Belgique, k CHU de Rouen

Augmentation enterocystoplasty (AE) is a third-line treatment for neurogenic detrusor overactivity (NDO). When the outcome of an AE is incomplete or comes to the end, botulinum toxin type A  (BTX-A) injections in the augmented bladder have been proposed . To date, this practice has not been evaluated in the literature. The aim of our study was to describe the practice and evaluate the results of detrusor injections of BTX-A in addition to an AE in patients with refractory NDO.

A retrospective multicenter study was conducted by members of the "Groupe de Neuro-Urologie de Langue Française" (GENULF), within nine academic centers. All patients (n = 27) who benefited from an AE and a supplementary detrusor injection of BTX-A for a NDO were included.
Clinical (epidemiological, surgical, functional) and uro-dynamic data (maximum cystometric capacity, detrusor pressure at first reflex detrusor contraction and at maximum cystometric capacity , reflex detrusor volume, bladder compliance) were collected from the medical files in a standardized questionnaire .


27 patients with various neurological disorders were included: 12 congenital disorders (spina bifida, sacral agenesis), 10 spinal cord injuries, 2 multiple sclerosis, and 3 neurogenic bladders of unknown aetiology. AE was performed with ileum in 16 cases and colon in 8 cases. Supratrigonal cystectomy was associated in 15 cases. Primary failure of AE occured in 11 cases and delayed failure in 14 cases. In case of delayed failure, the average duration between AE and failure was 10.4 years (1-26 years). BTX-A injections improved the symptoms, completely or partly, in 15 of 27 cases (55.5%). The clinical succes was associated with a request for reinjection in 14 patients (51,9%).

In our study, BTX-A injections provided a clinically significant benefit to 55.5% of patients. BTX-A injections are a treatment to consider in case of refractory NDO as a last resort  in a patient who previously had an AE.

Keywords : Botulinum toxin, bladder augmentation, enterocystoplasty, neurogenic detrusor overactivity, neurogenic bladder