Introduction: Apart from the standard intramural administration of botulinum neurotoxin A (BoNT/A) to the detrusor, intense research is taking place into new means of administration in view of the complex mechanism of action of BoNT/A. Methods: An open, randomised, prospective study was performed on a total of 23 patients with neurogenic detrusor overactivity. Following randomisation, patients were treated with 300 U of onabotulinumtoxinA (onaBoNT/A) in either the submucosa or the detrusor. Urodynamic examinations were carried out, and a bladder diary was kept both prior to and 12 weeks after the treatment. All patients stopped taking anticholinergics 1 week prior to the treatment. Results: In both the submucosa and detrusor groups, we recorded a significant improvement in the monitored urodynamic parameters and significant decreases in the frequency of urinary incontinence episodes following the treatment. A comparison of the two groups showed no significant difference between the two forms of application, with the exception of voided volume (p = 0.007). Conclusion: A comparison of the two administration methods did not show any significant difference between onaBoNT/A administration to the submucosa and to the detrusor. Thus, the submucosal injection of onaBoNT/A represents an equally effective approach for its administration to patients.

Keywords:
Botulinum neurotoxin, OnabotulinumtoxinA, Neurogenic detrusor overactivity, Submucosal administration
1.
Apostolidis A, Dasgupta P, Fowler CJ: Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol 2006;49:644-650.
2.
Vianello A, Proietti A, Giannantoni A: Effect of botulinum neurotoxin on the urinary bladder: novel insights on mechanism of action. Minerva Urol Nephrol 2010;62:259-271.
3.
Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford AP, Davis JB, Dasgupta P, Fowler CJ, Anand P: Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibres following intradetrusor injection of botulinum toxin for human detrusor overactivity. J Urol 2005;174:977-982.
4.
Ikeda Y, Zabbarova IV, Birder LA, de Groat WC, McCarthy CJ, Hanna-Mitchell AT, Kanai AJ: Botulinum neurotoxin serotype A suppresses neurotransmitter release from afferent as well as efferent nerves in the urinary bladder. Eur Urol 2012;62:1157-1164.
5.
Mangera A, Anderson KE, Apostolidis A, Chapple CR, Dasgupta P, Giannantoni A, Gravas S, Madersbacher S: Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA). Eur Urol 2011;60:784-795.
6.
Patel AK, Patterson JM, Chapple CR: Botulinum toxin injections for neurogenic and idiopathic detrusor overactivity: a critical analysis of results. Eur Urol 2006;50:684-710.
7.
Stoehrer M, Wolff A, Kramer G, Steiner R, Löchner-Ernst D, Leuth D, Steude U, Ruebben H: Treatment of neurogenic detrusor overactivity with botulinum toxin A: the first seven years. Urol Int 2009;83:379-385.
8.
Mehnert U, Boy S, Schmid M, Reitz A, von Hessling A, Hodler J, Schurch B: A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging. World J Urol 2009;27:397-403.
9.
Kuo HC: Therapeutic effects of suburothelial injection of botulinum A toxin for neurogenic detrusor overactivity due to chronic cerebrovascular accident and spinal cord lesions. Urology 2006;67:232-236.
10.
Krhut J, Šámal V, Němec P, Zvara P: Comparison of efficacy of intradetrusor and suburothelial injection of botulinum toxin A in patients with neurogenic detrusor overactivity associated to the spinal cord injury. Spinal Cord 2012;50:904-907.
11.
Santaniello F, Proietti S, Zucchi A, Costantini E, Vianello A, Porena M, Giannantoni A: Intravesical administration of botulinum A toxin in spinal cord injured patients: suburothelial versus intradetrusorial injections. Eur Urol Suppl 2007;6:245, abstract 889.
12.
Akbar M, Abel R, Seyler TM, Bedke J, Haferkamp A, Gerner HJ, Möhring K: Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction. BJU Int 2007;100:639-645.
13.
Kuo HC: Clinical effects of suburothelial injection of botulinum A toxin on patients with nonneurogenic detrusor overactivity refractory to anticholinergics. Urology 2005;66: 94-98.
14.
Okamura K, Nojiri Y, Ameda K, Namima T, Suzuki M, Inoue K, Ogawa T, Gotoh M, Homma Y: Botulinum toxin A submucosal injection for refractory non-neurogenic overactive bladder: early outcomes. Int J Urol 2011;18:483-487.
15.
Onyeka BA, Shetty A, Ilangovan K, Saxena A: Submucosal injections of botulinum toxin A in women with refractory idiopathic detrusor overactivity. Int J Gynaecol Obstet 2010;110:68-69.
16.
Kuo HC: Preliminary results of suburothelial injection of botulinum a toxin in the treatment of chronic interstitial cystitis. Urol Int 2005;75:170-174.
17.
Cruz F, Herschon S, Aliotta P, Brin M, Thompson C, Lam W, Daniell G, Heesakkers J, Haag-Molkenteller C: Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomized, double-blind, placebo-controlled trial. Eur Urol 2011;60:742-750.
18.
Ginsberg D, Gousse A, Keppenne V, Sievert KD, Thompson C, Lam W, Brin MF, Jenkins B, Haag-Molkenteller C: Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol 2012;187:2131-2139.
19.
Sievert KD, Heesakkers J, Ginsberg D, Cruz F, Jenkins B, Thompon C, Lam W, Haag-Molkenteller C: Efficacy of onabotulinumtoxinA in neurogenic detrusor overactivity is independent of concomitant anticholinergic use (online); in European Association of Urology: Abstracts Online. March 30, 2012. http://www.uroweb.org/events/abstracts-online/?AID=37763.
20.
Bauer RM, Gratzke C, Roosen A, Hocaoglu Y, Mayer ME, Buchner A, Stief CG, May F: Patient-reported side effects of intradetrusor botulinum toxin type A for idiopathic overactive bladder syndrome. Urol Int 2011;86:68-72.
21.
Mouttalib S, Khan S, Castel-Lacanal E, Guillotreau J, De Boissezon X, Malavaud B, Marque P, Rischmann P, Gamé X: Risk of urinary tract infection after detrusor botulinum toxin A injections for refractory neurogenic detrusor overactivity in patients with no antibiotic treatment. BJU Int 2010;106:1677-1680.
22.
Gamé X, Castel-Lacanal E, Bentaleb Y, Thiry-Escudié I, De Boissezon X, Malavaud B, Marque P, Rischmann P: Botulinum toxin A detrusor injection in patients with neurogenic detrusor overactivity significant decrease the incidence of symptomatic urinary tract infections. Eur Urol 2008;53:613-618.
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2013
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