Satisfaction and quality of life issues in patients receiving urethral botulinum toxin A injections for detrusor sphincter dyssynergia and detrusor botulinum toxin A injections for neurogenic detrusor overactivity

Detrusor sphincter dyssynergia (DSD) and neurogenic detrusor overactivity (NDO) are common conditions in patients with spinal cord injury, multiple sclerosis, and transverse myelitis. With advancements in the clinical application of botulinum toxin A (onabotulinumtoxinA, BoNT-A) injections in the treatment of chronic lower urinary tract dysfunction, there has been much improvement in the management of DSD and NDO. Therefore, we reviewed the current literature with focus on subjective outcomes and patient satisfaction scores after BoNT-A treatment. We searched PubMed for articles on the management of neurogenic bladder using the following keywords: DSD, NDO, BoNT-A, satisfaction, dissatisfaction, quality of life, urodynamics, and lower urinary tract dysfunction. Patients receiving BoNT-A urethral injections for DSD have improvements in voiding volume, decreased postvoid residual (PVR) urine, and maximal urethral pressure. Most patients are satisfied and benefit from less difficult urination. However, some patients are dissatisfied with increased urinary incontinence. The BoNT-A detrusor injections for NDO can significantly increase reflex volume and maximal bladder capacity as well as decrease uninhibited bladder contractions. Most patients are satisfied with reduced urinary incontinence. However, some patients are dissatisfied with increased volumes of PVR urine and more difficult urination. Although published clinical studies usually include only a small number of patients and lack randomization and placebo-controlled groups, they provide important evidence of subjective improvement in the management of patients with DSD and NDO using BoNT-A injections. Urologists should inform patients about the main therapeutic effects and possible disadvantages of BoNT-A injections