Turkish Journal of Physical Medicine and Rehabilitation 2005 , Vol 51 , Num 3

Intravesical Botulinum-A Toxin Injection in the Treatment of Neurogenic Detrusor Overactivity: A Case Report and Literature Review

Yeşim Akkoç 1 ,Selcen Özdedeli 1 ,Kaan Özdedeli 2
1 Ege Üniversitesi Tıp Fakültesi Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İzmir
2 Ege Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı, İzmir

A 45-year-old man applied to our department with the complaints of urinary and faecal incontinence and muscle weakness in the lower limbs. He had progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins.In the first urodynamic examination, maximum cystometric bladder capacity was 164 ml and maximum detrusor pressure was 50 cmH2O with detrusor-sphincter dyssinergia. Intermittent self-catheterization and oxybutynin chloride 10 mg daily was started. One year later, it was increased to 15 mg daily as it was ineffective to achieve continence. As the patient had a problem of dry mouth, it was changed to tolterodine 4 mg daily. The patient showed inadequate response to this treatment one year later. He still had detrusor overactivity and incontinence episodes between intermittent catheterisations. Botulinum-A toxin injection into the detrusor muscle of this patient was decided as the incontinence was resistant to anticholinergic therapy. A total of 300 units of botulinum-A toxin were injected with a custom made 6 Fr flexible injection needle at 30 detrusor muscle sites. Urodynamic examination which was done 4 months after the injection revealed that maximum cystometric bladder capacity increased from 108 to 250 ml and maximum detrusor pressure decreased from 63 to 35 cmH2O. 

Keywords : Neurogenic bladder, urinary incontinence, botulinum-A toxi