Systematic review of therapy for neurogenic detrusor overactivity

While many neurologic diseases predispose patients to neurogenicdetrusor overactivity (NDO), the only populations that have beensystematically studied are adults with multiple sclerosis (MS), adultswith spinal cord injury (SCI) and children and young adults withmyelodysplasia. First-line pharmacotherapy for NDO is an antimuscarinicdrug. However, the evidence base for these agents inthis indication is poor. There is some high-quality evidence for theefficacy of detrusor injections of botulinum toxin A in the treatmentof NDO, with significant reduction in urgency incontinence episodes,improved urodynamic parameters, and improved quality oflife. While few adverse events have been reported with this therapy,there is a need for intermittent self-catheterization in these groups.