Prospective Evaluation of Intradetrusor Injections of OnabotulinumtoxinA in Adults With Spinal Dysraphism

Alexander Mackay, Rachel Sosland, Khue Tran, Julie Stewart, Timothy Boone, Rose Khavari

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To prospectively evaluate the effectiveness of OnabotulinumtoxinA (BTX-A) on neurogenic overactive bladder (nOAB) in adults with congenital spinal dysraphism (CSD). Methods: We conducted a prospective, nonrandomized pilot study of 24 adults with CSD and neurogenic overactive bladder. Patients were evaluated with baseline video-urodynamics (UDS) and validated questionnaires, underwent injection 200U BTX-A, and then underwent repeat evaluation with questionnaires and UDS 1-3 months postinjection. A high-risk subgroup was separately analyzed based on adverse clinical characteristics (ie, decrease bladder compliance, vesicoureteral reflux, hydronephrosis, chronic kidney disease). Results: BTX-A injection improved patient recorded outcome measures seen in both I-QOL Score total (67.9 vs 75.5, P = .007) and Neurogenic Bladder Symptom Score total (38.0 vs 29.0, P = .001). On UDS, BTX-A injection significantly improved end filling pressure (16.0 vs 8.8, P = .036) and also improved bladder compliance (mL/cm H2O) (89.38 vs 135.81, P = .445). High-risk patients were found to have similar improvements in most subjective questionnaire scoring, a significant decrease in end filling pressures, and improved bladder compliance on UDS. Conclusion: BTX-A can be used as an effective treatment in adults with CSD. We found that BTX-A significantly improved quality of life from patient reported outcome measurements as well as improving end filling pressures and bladder compliance. These improvements were seen even within our high-risk subgroup. Further studies are needed to evaluate long-term efficacy and appropriate follow-up of this at-risk population.

Original languageEnglish (US)
Pages (from-to)146-152
Number of pages7
StatePublished - Mar 2022


  • Adult
  • Botulinum Toxins, Type A/adverse effects
  • Female
  • Humans
  • Male
  • Neuromuscular Agents/adverse effects
  • Pilot Projects
  • Quality of Life
  • Spinal Dysraphism/complications
  • Treatment Outcome
  • Urinary Bladder, Neurogenic/drug therapy
  • Urinary Bladder, Overactive/drug therapy
  • Urodynamics

ASJC Scopus subject areas

  • Urology


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