Article

OBJECTIVE: To conduct a systematic review and meta-analysis to examine the effect
of injecting botulinum toxin A (BTX-A) into the detrusor sphincter on improving
bladder emptying 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 September 2011. DATA SELECTION: All trials
examining the use of BTX-A injections into the detrusor sphincter for the
treatment for incomplete bladder emptying after SCI were included if at least 50%
of the study sample comprised subjects with SCI, and if the SCI sample size was 3
or greater. DATA EXTRACTION: A standardized mean difference (SMD) +/- SE and 95%
confidence interval (CI) were calculated for each outcome of interest, and the
results were pooled using a fixed or random effects model, as appropriate.
Outcomes assessed included postvoid residual urine volume (PRV), detrusor
pressure (PDet), and urethral pressure (UP). Effect sizes were interpreted as
small, 0.2; moderate, 0.5; and large, 0.8. DATA SYNTHESIS:
A relatively limited
number of studies (2 randomized controlled trials, 6 uncontrolled trials) were
identified. The 8 studies included results from 129 subjects. There was a
statistically significant decrease in PRV at 1 month (SMD=1.119+/-.140; 95% CI,
.844-1.394; P<.001), with a pooled mean PRV decrease from 251.8 to 153.0 mL.
There was a moderate statistical effect on PDet (SMD=.570+/-.217; 95% CI,
.145-.995; P=.009); pooled PDet decreased from 88.7 to 20.5 cmH(2)O. A large
statistical effect size on UP (SMD=.896+/-.291; 95% CI, .327-1.466; P=.002) and
an improvement from 119.7 to 102.3 cmH(2)O were seen. The systematic review also
indicated a 50% reduction in urinary tract infections based on 3 studies.
Discontinuation or reduction in catheter usage was reported in 4 studies after
BTX-A. CONCLUSIONS: Results of the meta-analysis indicate that BTX-A is effective
in reducing PRV and demonstrating a statistically significant reduction in PDet
and UP 1 month postinjection. However, the clinical utility of BTX-A is yet to be
determined.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS