Botulinumtoxin Injection Versus Augmentation Cystoplasty for Neurogenic Bladder: Where Do We Stand?

• Published in: Current bladder dysfunction reports Vol. 18; no. 4; pp. 299 - 303
• Main Authors: Sweeney, Tara, Zilinskas, Kasparas, Cox, Lindsey
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-12-2023
• Subjects: Geriatrics/Gerontology; Gynecology; Medicine; Medicine & Public Health; Review; Topical Collection on Reconstructed Bladder Function & Dysfunction; Urology; Overactive bladder; Urological surgery; Botulinumtoxin; Augmentation cystoplasty; Urology; Neurogenic bladder
• ISSN: 1931-7212; 1931-7220
• DOI: 10.1007/s11884-023-00719-1

Purpose of Review
Patients with neurogenic bladder often present with overactive, low capacity, and poorly compliant bladders with discoordination of their internal and external urethral sphincters. As a result of poor compliance, high detrusor pressures can cause reflux into the upper tracts. This constellation of findings can also cause bothersome lower urinary tract symptoms. There are various modes of management for patients with neurogenic bladder ranging from conservative methods to major reconstructive surgery in efforts to prevent upper tract deterioration and to treat voiding dysfunction. This paper aims to review the current practices in treatment decision making when offering botulinumtoxin A versus augmentation cystoplasty for management of neurogenic detrusor overactivity.
Recent Findings
A comprehensive review was performed using PubMed and Cochrane Library from January of 2018 to April of 2023. As treatment for refractory neurogenic detrusor overactivity advances, intravesical BTX-A and augmentation cystoplasty are effective options for management, both independently and when used in combination.
Summary
From more recent literature, the approach in choosing which option is more clinically effective in terms of continence rates, improvement in urodynamic parameters, and patient satisfaction is progressing towards being more patient-centered rather than following an algorithm that progresses from least invasive to most invasive management.