Article

OBJECTIVE: To examine the effectiveness of botulinum toxin type A (BTX-A) on
neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury
(SCI). DATA SOURCES: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were
searched for all relevant articles published from 1980 to June 2012. STUDY
SELECTION: Trials examining the use of BTX-A injections into the detrusor wall in
the treatment of NDO after SCI were included if (1) >/= 50% of study sample
comprised subjects post-SCI; (2) outcomes of interest were assessed before and
after treatment with a single injection of BTX-A; and (3) the sample size was >/=
3. DATA EXTRACTION: A standardized mean difference +/- SE (95% confidence
interval) was calculated for at least 1 of the following outcomes in every study:
postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder
compliance, catheterization frequency, and maximum flow rate. Results from all
studies were then pooled using a random-effects model. Treatment effect sizes
were interpreted as small, >0.2; moderate, >0.5; or large, >0.8. DATA SYNTHESIS:
Fourteen studies representing data from 734 subjects were included. After BTX-A
injection, large treatment effects were observed in postvoid residual urine
volume, reflex detrusor volume, bladder capacity, bladder compliance, and
catheterization frequency (P<.01). Rate of incontinence episodes was reduced from
23% to 1.31% after BTX-A treatment. No significant decrease in max flow rate was
observed (P=.403). CONCLUSIONS: Results of the meta-analysis indicate BTX-A is
effective in treating NDO after SCI. The use of BTX-A was associated with a
decrease in incontinence episodes, catheter use, and bladder pressures.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
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Langue : ANGLAIS