TY - JOUR
T1 - Neurotoxin treatments for urinary incontinence in subjects with spinal cord injury or multiple sclerosis
T2 - A systematic review of effectiveness and adverse effects
AU - MacDonald, Roderick
AU - Monga, Manoj
AU - Fink, Howard A.
AU - Wilt, Timothy J.
PY - 2008
Y1 - 2008
N2 - Background/Objective: The objective was to evaluate the effectiveness of neurotoxin treatments of urinary incontinence (Ul) in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). Methods: Studies were included if published in English, presented randomized adults with SCI or MS, and reported Ul outcomes. Results: Ten trials randomizing 288 subjects with SCI (43%), MS (52%), or other spinal conditions (5%) and Ul refractory to oral antimuscarinics were included. The overall mean age was 41 years, and 46% were women. Study durations ranged from 1 to 18 months. Treatments included botulinum toxin-A (BTX-A, 2 trials) and 2 vanilloid compounds, capsaicin (6 trials) and resiniferatoxin (4 trials). BTX-A was superior to placebo and resiniferatoxin in reducing daily Ul episodes, mainly in individuals with SCI, although significant reductions vs placebo were not evident throughout the study duration. There were 1.1 fewer daily Ul episodes in the BTX-A 200 unit group vs 0.1 fewer for the placebo group at the final week 24 assessment. Capsaicin was generally superior to placebo. The weighted difference between capsaicin and placebo in a pooled analysis of 2 trials enrolling subjects with either paraplegia or tetraplegia (n = 32) was -3.8 daily Ul episodes [95% CI -4.7 to -2.9] after 30 days. Capsaicin was comparable to resiniferatoxin. Pelvic pain and facial flushing were associated with capsaicin. Conclusion: Neurotoxins may improve refractive Ul in adults with SCI or MS, although trial results were inconsistent. Trials were small in size and relatively short in duration. Further studies are needed to determine the efficacy and tolerability of long-term application.
AB - Background/Objective: The objective was to evaluate the effectiveness of neurotoxin treatments of urinary incontinence (Ul) in individuals with spinal cord injury (SCI) or multiple sclerosis (MS). Methods: Studies were included if published in English, presented randomized adults with SCI or MS, and reported Ul outcomes. Results: Ten trials randomizing 288 subjects with SCI (43%), MS (52%), or other spinal conditions (5%) and Ul refractory to oral antimuscarinics were included. The overall mean age was 41 years, and 46% were women. Study durations ranged from 1 to 18 months. Treatments included botulinum toxin-A (BTX-A, 2 trials) and 2 vanilloid compounds, capsaicin (6 trials) and resiniferatoxin (4 trials). BTX-A was superior to placebo and resiniferatoxin in reducing daily Ul episodes, mainly in individuals with SCI, although significant reductions vs placebo were not evident throughout the study duration. There were 1.1 fewer daily Ul episodes in the BTX-A 200 unit group vs 0.1 fewer for the placebo group at the final week 24 assessment. Capsaicin was generally superior to placebo. The weighted difference between capsaicin and placebo in a pooled analysis of 2 trials enrolling subjects with either paraplegia or tetraplegia (n = 32) was -3.8 daily Ul episodes [95% CI -4.7 to -2.9] after 30 days. Capsaicin was comparable to resiniferatoxin. Pelvic pain and facial flushing were associated with capsaicin. Conclusion: Neurotoxins may improve refractive Ul in adults with SCI or MS, although trial results were inconsistent. Trials were small in size and relatively short in duration. Further studies are needed to determine the efficacy and tolerability of long-term application.
KW - Botulinum toxin
KW - Capsaicin
KW - Detrusor overactivity
KW - Multiple sclerosis
KW - Neurogenic bladder
KW - Resiniferatoxin
KW - Spinal cord injuries
KW - Systematic review
KW - Urinary incontinence
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U2 - 10.1080/10790268.2008.11760706
DO - 10.1080/10790268.2008.11760706
M3 - Review article
C2 - 18581662
AN - SCOPUS:46749088355
VL - 31
SP - 157
EP - 165
JO - Journal of Spinal Cord Medicine
JF - Journal of Spinal Cord Medicine
SN - 1079-0268
IS - 2
ER -