To botox or not to botox


That is the question: Whether ’tis nobler in mind to suffer
The slings and arrows of bladder instability,
Or to take arms against a sea of troubles,
And by opposing end them?
Shakespeare a’la NDG

Bladder botox treatment

If you suffer from bladder dysfunction, ask yourself why put with the dry mouth from Vesicare and Co., when a few injections of botox per year will do? It works well in a majority of cases with immediate noticeable differences, but long-term efficacy data is hard to come by.

The work presented below provides long-term follow up data on 107 people – 61% spinal cord injury and 36% MS, on the effects of botox on bladder dysfunction up to 7 years. The only minus point is that it only looks at those responded well at the outset.

When compared to pre-botox, post-botox there was improvement clinically, on subject rating and in the overall bladder volume capacity for urine (see Table below). Even 24 months after the initial 5 years of treatment 67% of people responded to follow up injections. The mean time interval was 8.4 months between injections with on average 8.9 injections in total.

There is tolerance to the injections overtime and this was noted in one fourth of people receiving botox.

Table: Impact of botox injections on clinical symptoms, score symptoms, and maximum cystometric capacity in those with neurogenic hyperactive bladder


Low Urin Tract Symptoms. 2019 Dec 19. doi: 10.1111/luts.12297. [Epub ahead of print]

How long does the effect of botulinum toxin in neurogenic patients last? An analysis of the subset of “good responders”.

Dominique I, Tremblais B, Charvier K, Nogueira MCS, Paparel P, Journel NM, Ruffion A.


The aim of this study was to assess long-term efficacity of botulinum neurotoxin A (BoNT-A) in the treatment of neurogenic detrusor overactivity (NDO).


This was a retrospective monocentric study in a reference center. We included patients who received intradetrusor BoNT-A for NDO between 2001 and 2015. The focus of our analysis was on patients defined as “good responders” (≥ 5 injections of intradetrusor BoNT-A over a period of ≥5 years). The primary endpoint was the evaluation of long-term efficacity of BoNT-A. Recurrent NDO was monitored by the use of cystomanometry before the first injection and 1 month after each injection. The secondary objective was to assess the influence of NDO’s etiology, age, and sex on the long-term efficacity of the treatment.


A total of 107 patients were included (60.7% with spinal cord injury [SCI] and 36.4% with multiple sclerosis [MS]). The mean follow-up period was 83.7 months (66; 120). The mean number of injections was of 8.9 (5; 21). A total of 67.3% (n = 72) of patients were still controlled by treatment at the end of their follow-up period. Therapeutic failure occurred in 30 patients (26.1%) with a cessation of BoNT-A treatment at 76 months on average (median: 82.5 months). There was no significant impact of age (P = .42), sex (P = .35), or NDO’s etiology (MS vs SCI; P = .54) on long-term efficacy of BoNT-A treatment.


The results of our study indicate that the application of BoNT-A seems to be an effective and durable treatment in a large number of neurogenic patients after more than 10 years of follow-up. However, botulinum toxin tolerance occurred in approximately 25% of patients.

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Neuro Doc Gnanapavan

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