eMedicineLive

Urinary incontinence resulting from detrusor over activity in patients with spinal cord injury and multiple sclerosis (MS) can now be treated with Botox. The use of onabotulinum toxin A (Botox, Allergan Inc) in such conditions has been given the approval by the Food and Drug Administration (FDA) today. 

 

Certain neurological conditions can lead to uninhibited contractions of the urinary bladder. This makes it difficult to hold urine. At present, anticholinergic medicines are used to treat this condition. Otherwise the patient is catheterized. However, not all patients respond to anticholinergic medicines and some of the patients cannot tolerate these medicines. Catherization for a long time, besides being inconvenient to the patient, has its own complications. The FDA has approved the use of Botox in managing such patients.

 

The FDA approval to onabotulinum toxin A is based on the encouraging results shown by two studies. These clinical trials were done on involving 691 patients with spinal cord injury and MS. While one study was presented at the European Association of Urology 26th Annual Congress, the other was presented at the American Urological Association 2011 Annual Scientific Meeting. In both the studies the patients were randomly divided into two groups and were either given onabotulinum toxin A or a placebo. A statistically significant decrease in the weekly frequency of incontinence episodes was seen in patients who were put on Botox.

 

Botox, when injected into the bladder, results in its relaxation and increases the storage capacity of the bladder to hold urine. The injection is given while doing a cystoscopy. The effect of Botox lasts for about nine months. Rarely, the injection may result in urinary infection and retention. The patient may have to be catherized to empty the bladder in such a scenario.

 

According to George Benson, MD, deputy director of the FDA's Division of Reproductive and Urologic Products, treating urinary incontinence following spinal injury or MS has always been very challenging to the doctors. Approval given by the FDA to onabotulinum toxin A has given a ray of hope to such patients.

 

References:

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