Individual research recommendation details

Recommendation ID

CG148/2

Question

Safety and efficacy of botulinum toxin:- What is the safety and efficacy of botulinum toxin compared with (a) usual care, (b) antimuscarinics and (c) augmentation cystoplasty in people with neurogenic lower urinary tract dysfunction?

Any explanatory notes
(if applicable)

Why this is important:- Further research is needed to determine whether repeated intradetrusor injections of botulinum toxin type A have long-term efficacy. The efficacy in terms of continence and upper urinary tract preservation should be studied. Botulinum toxin injection into the detrusor is an effective means of managing incontinence and improves urodynamic measures of bladder storage with the potential to protect the kidneys from
the effects of high intravesical pressures. It is well tolerated in a spectrum of conditions and ages. However, the longer term efficacy over many injections has not been established. A clinical trial is needed to study the outcome in terms of continence and renal preservation over many cycles of repeated injection. Quality of life is an important outcome. A trial should enrol children and adults. The indications for botulinum toxin need not be modified for inclusion, but entrants into a trial must have anatomically normal kidneys (on imaging) and normal renal function.

Source guidance details

Comes from guidance

Urinary incontinence in neurological disease: assessment and management

Number

CG148

Date issued

August 2012

Other details