Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Onabotulinum toxin A improves neurogenic detrusor overactivity following spinal cord injury: a systematic review and meta-analysis

Spinal Cord volume 62, pages 285–294 (2024)Cite this article

Subjects

Abstract

Study design

Systematic review and meta-analysis.

Objectives

The current study aimed to assess the efficacy and safety of Onabotulinum toxin A (OBTX-A) treatment for neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients.

Setting

Iran.

Methods

All relevant articles of clinical trials and cohort studies indexed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases up to September 6, 2022, that addressed OBTX-A treatment for NDO following SCI were included. The quality of eligible studies was evaluated using Cochrane criteria. Also, the weighted mean difference (WMD) was measured with a random-effect model.

Results

Regarding the overall efficacy after OBTX-A treatment in the short term, volume per void (VV) (WMD = 118.8, 95% CI: 90.9–146.7, p < 0.01), incontinence-quality of life (IQoL) (WMD = 24.3, 95% CI: 15.8–32.8, p < 0.01), and maximum cystometric capacity (MCC) (WMD = 144.5, 95% CI: 132.3 to 156.7, p < 0.01) significantly increased, while maximum detrusor pressure during storage (MDP) (WMD = –30.5, 95% CI: –35.9 to –25.1, p < 0.01) showed a significant decrease. Furthermore, compared to the placebo group at the 200-unit dose, there was a significant increase in MCC (WMD = 113.5, 95% CI: 84.7 to 142.3, p < 0.01) and a significant decrease in MDP (WMD = −27.2, 95% CI: −39.2 to −15.1, p < 0.01). Urinary tract infection (UTI), hematuria, and autonomic dysreflexia were the most common side effects, occurring at rates of 29.6%, 14.8%, and 13.4%, respectively.

Conclusion

Our findings highlighted the effectiveness and safety of OBTX-A as a promising treatment of NDO following SCI.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3: Forest plot of the meta-analysis of short- and long-term efficiency of Onabotulinum toxin A on maximum detrusor pressure (MDP) during storage.
Fig. 4: Forest plot of the meta-analysis of short- and long-term efficiency of Onabotulinum toxin A on maximum cytometric capacity (MCC).

Similar content being viewed by others

Data availability

All the required information is in the manuscript and supplementary file.

References

  1. Chow PM, Kuo HC. Botulinum toxin A injection for autonomic dysreflexia-detrusor injection or urethral sphincter injection? Toxins (Basel). 2023;15:108.

    Article  CAS  PubMed  Google Scholar 

  2. Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50:365–72.

    Article  CAS  PubMed  Google Scholar 

  3. Wöllner J, Pannek J. Initial experience with the treatment of neurogenic detrusor overactivity with a new β-3 agonist (mirabegron) in patients with spinal cord injury. Spinal Cord. 2016;54:78–82.

    Article  PubMed  Google Scholar 

  4. Huang YH, Chen SL. Concomitant detrusor and external urethral sphincter botulinum toxin-A injections in male spinal cord injury patients with detrusor overactivity and detrusor sphincter dyssynergia. J Rehabil Med. 2022;54:jrm00264.

    Article  PubMed  Google Scholar 

  5. Mehta S, Hill D, McIntyre A, Foley N, Hsieh J, Ethans K, et al. Meta-analysis of botulinum toxin A detrusor injections in the treatment of neurogenic detrusor overactivity after spinal cord injury. Arch Phys Med Rehabil. 2013;94:1473–81.

    Article  PubMed  Google Scholar 

  6. Bellucci CH, Wöllner J, Gregorini F, Birnböck D, Kozomara M, Mehnert U, et al. Acute spinal cord injury-do ambulatory patients need urodynamic investigations? J Urol. 2013;189:1369–73.

    Article  PubMed  Google Scholar 

  7. Chen SF, Jiang YH, Kuo HC. Single onabotulinumtoxinA 200U dose improved clinical symptoms but not urothelial dysfunction in neurogenic detrusor overactivity due to spinal cord injury. J Formos Med Assoc. 2019;118:125–33.

    Article  PubMed  Google Scholar 

  8. Giannantoni A, Mearini E, Del Zingaro M, Porena M. Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: clinical and urodynamic results. Eur Urol. 2009;55:705–11.

    Article  CAS  PubMed  Google Scholar 

  9. Julian PTH, James T, Jacqueline C, Miranda C, Tianjing L, Matthew JP, et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019.

    Google Scholar 

  10. Matthew JP, Joanne EM, Patrick MB, Isabelle B, Tammy CH, Cynthia DM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Google Scholar 

  11. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj. 2011;343:d5928.

    Article  PubMed  PubMed Central  Google Scholar 

  12. R Core Team (2023). _R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/.

  13. Reitz A, Stöhrer M, Kramer G, Del Popolo G, Chartier-Kastler E, Pannek J, et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol. 2004;45:510–5.

    Article  CAS  PubMed  Google Scholar 

  14. Cochran GW. The comparison of percentages in matched samples. Biometrika. 1950;37:256–66.

    Article  CAS  PubMed  Google Scholar 

  15. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  16. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  17. McGuinness L robvis: An R package and web application for visualising risk-of-bias assessments [Internet]. 2019.

  18. Lin CC, Kuo HC. Video-urodynamic characteristics and predictors of switching from botulinum neurotoxin a injection to augmentation enterocystoplasty in spinal cord injury patients. Toxins (Basel). 2022;14:47.

    Article  PubMed  Google Scholar 

  19. Honda M, Yokoyama O, Takahashi R, Matsuda T, Nakayama T, Mogi T. Botulinum toxin injections for Japanese patients with urinary incontinence caused by neurogenic detrusor overactivity: Clinical evaluation of onabotulinumtoxinA in a randomized, placebo-controlled, double-blind trial with an open-label extension. Int J Urol. 2021;28:906–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Chen H, Xie K, Jiang C. A single-blind randomized control trial of trigonal versus nontrigonal Botulinum toxin-A injections for patients with urinary incontinence and poor bladder compliance secondary to spinal cord injury. J Spinal Cord Med. 2021;44:757–64.

    Article  CAS  PubMed  Google Scholar 

  21. Walter M, Kran SL, Ramirez AL, Rapoport D, Nigro MK, Stothers L, et al. Intradetrusor onabotulinumtoxinA injections ameliorate autonomic dysreflexia while improving lower urinary tract function and urinary incontinence-related quality of life in individuals with cervical and upper thoracic spinal cord injury. J Neurotrauma. 2020;37:2023–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hebert KP, Klarskov N, Bagi P, Biering-Sørensen F, Elmelund M. Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury. Spinal Cord. 2020;58:675–81.

    Article  PubMed  Google Scholar 

  23. Hui C. Safety and efficacy of trigonal BTX-A injections for children with neurological detrusor overactivity secondary to spinal cord injury. J Pediatr Surg. 2020;55:2736–9.

    Article  PubMed  Google Scholar 

  24. Walter M, Kran SL, Nigro MK, Stothers L, Rapaport D, Kavanagh A, et al. Onabotulinumtoxina ameliorates autonomic dysreflexia while improving lower urinary tract function and quality of life in individuals with spinal cord injury. Neurourol Urodyn. 2018;37:S88–S9.

    Google Scholar 

  25. Ferreira RS, D’Ancona CAL, Oelke M, Carneiro MR. Intradetrusor onabotulinumtoxinA injections are significantly more efficacious than oral oxybutynin for treatment of neurogenic detrusor overactivity: results of a randomized, controlled, 24-week trial. Einstein (Sao Paulo). 2018;16:eAO4207.

    Article  PubMed  Google Scholar 

  26. Huang Y-H, Chen S-L, editors. Concomitant onabotulinumtoxinA detrusor and sphincter injection in patients with suprasacral spinal cord injury. Int J Urol. 2018: Wiley 111 River ST, Hoboken 07030-5774, NJ USA.

  27. Fougere RJ, Currie KD, Nigro MK, Stothers L, Rapoport D, Krassioukov AV. Reduction in bladder-related autonomic dysreflexia after onabotulinumtoxinA treatment in spinal cord injury. J Neurotrauma. 2016;33:1651–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Chen SF, Chang CH, Kuo HC. Clinical efficacy and changes of urothelial dysfunction after repeated detrusor botulinum toxin A injections in chronic spinal cord-injured bladder. Toxins (Basel). 2016;8:164.

    Article  PubMed  Google Scholar 

  29. Hui C, Keji X, Chonghe J, Ping T, Rubiao O, Jianweng Z, et al. Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity. Spinal Cord. 2016;54:46–50.

    Article  CAS  PubMed  Google Scholar 

  30. Al Taweel W, Alzyoud KM. The effect of spinal cord-injury level on the outcome of neurogenic bladder treatment using OnabotulinumtoxinA. Urol Ann. 2015;7:320–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Yang WX, Zhu HJ, Chen WG, Zhang DW, Su M, Feng JF, et al. Treatment of detrusor external sphincter dyssynergia using ultrasound-guided trocar catheter transurethral botulinum toxin a injection in men with spinal cord injury. Arch Phys Med Rehabil. 2015;96:614–9.

    Article  PubMed  Google Scholar 

  32. Sengoku A, Okamura K, Kimoto Y, Ogawa T, Namima T, Yamanishi T, et al. Botulinum toxin A injection for the treatment of neurogenic detrusor overactivity secondary to spinal cord injury: multi-institutional experience in Japan. Int J Urol. 2015;22:306–9.

    Article  CAS  PubMed  Google Scholar 

  33. Álvares RA, Araújo ID, Sanches MD. A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics. BMC Urol. 2014;14:66.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fougere RJ OnabotulinumtoxinA treatment for neurogenic detrusor overactivity and the prevention of autonomic dysreflexia following spinal cord injury: University of British Columbia; 2014.

  35. Chen YC, Kuo HC. The therapeutic effects of repeated detrusor injections between 200 or 300 units of onabotulinumtoxinA in chronic spinal cord injured patients. Neurourol Urodyn. 2014;33:129–34.

    Article  CAS  PubMed  Google Scholar 

  36. Chen SF, Kuo HC. Therapeutic outcome and patient adherence to repeated onabotulinumtoxinA detrusor injections in chronic spinal cord-injured patients and neurogenic detrusor overactivity. J Formos Med Assoc. 2015;114:583–9.

    Article  CAS  PubMed  Google Scholar 

  37. Jia C, Liao LM, Chen G, Sui Y. Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury. Spinal Cord. 2013;51:487–90.

    Article  CAS  PubMed  Google Scholar 

  38. Šámal V, Mečl J, Šrám J. Submucosal administration of onabotulinumtoxinA in the treatment of neurogenic detrusor overactivity: pilot single-centre experience and comparison with standard injection into the detrusor. Urol Int. 2013;91:423–8.

    Article  PubMed  Google Scholar 

  39. Apostolidis A, Thompson C, Yan X, Mourad S. An exploratory, placebo-controlled, dose-response study of the efficacy and safety of onabotulinumtoxinA in spinal cord injury patients with urinary incontinence due to neurogenic detrusor overactivity. World J Urol. 2013;31:1469–74.

    Article  CAS  PubMed  Google Scholar 

  40. Chen S-F, Kuo H-C. Improvement in autonomic dysreflexia after detrusor onabotulinumtoxinA injections in patients with chronic spinal cord injuries. Tzu Chi Med J. 2012;24:201–4.

    Article  Google Scholar 

  41. Krhut J, Samal V, Nemec D, Zvara P. Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study. Spinal Cord. 2012;50:904–7.

    Article  CAS  PubMed  Google Scholar 

  42. Ginsberg D, Gousse A, Keppenne V, Sievert KD, Thompson C, Lam W, et al. Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol. 2012;187:2131–9.

    Article  CAS  PubMed  Google Scholar 

  43. Proietti S, Conte A, Giovannozzi S, Lepri E, Porena M, Berardelli A, et al. Clinical and neurophysiologic effects of botulinum A toxin on neurogenic and idiopathic detrusor overactivity. Eur Urol, Suppl. 2011;10:190.

    Article  Google Scholar 

  44. Kuo HC, Liu SH. Effect of repeated detrusor onabotulinumtoxinA injections on bladder and renal function in patients with chronic spinal cord injuries. Neurourol Urodyn. 2011;30:1541–5.

    Article  PubMed  Google Scholar 

  45. Chen CY, Liao CH, Kuo HC. Therapeutic effects of detrusor botulinum toxin A injection on neurogenic detrusor overactivity in patients with different levels of spinal cord injury and types of detrusor sphincter dyssynergia. Spinal Cord. 2011;49:659–64.

    Article  PubMed  Google Scholar 

  46. Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2011;60:742–50.

    Article  CAS  PubMed  Google Scholar 

  47. Chen G, Liao L. Injections of botulinum toxin A into the detrusor to treat neurogenic detrusor overactivity secondary to spinal cord injury. Int Urol Nephrol. 2011;43:655–62.

    Article  CAS  PubMed  Google Scholar 

  48. Alvares RA, Silva JA, Barboza AL, Monteiro RT. Botulinum toxin A in the treatment of spinal cord injury patients with refractory neurogenic detrusor overactivity. Int Braz J Urol. 2010;36:732–7.

    Article  PubMed  Google Scholar 

  49. Ferreira R, D’Ancona C, Rassi M. Comparative study between oral oxybutynin and intradetrusor injections of botulinum toxin type a (botox®) in patients with bladder dysfunction following traumatic spinal cord injury: Urodynamic response and effect on quality of life. Neurourol Urodyn. 2010;29:991–2.

    Google Scholar 

  50. Abdel-Meguid TA. Botulinum toxin-A injections into neurogenic overactive bladder-to include or exclude the trigone? A prospective, randomized, controlled trial. J Urol 2010;184:2423–8.

    Article  CAS  PubMed  Google Scholar 

  51. Mehnert U, Boy S, Schmid M, Reitz A, von Hessling A, Hodler J, et al. A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging. World J Urol. 2009;27:397–403.

    Article  CAS  PubMed  Google Scholar 

  52. Do Ngoc Thanh C, Audry G, Forin V. Botulinum toxin type A for neurogenic detrusor overactivity due to spinal cord lesions in children: a retrospective study of seven cases. J Pediatr Urol. 2009;5:430–6.

    Article  PubMed  Google Scholar 

  53. Pannek J, Göcking K, Bersch U. Long-term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction. BJU Int. 2009;104:1246–50.

    Article  CAS  PubMed  Google Scholar 

  54. Chen SL, Bih LI, Huang YH, Tsai SJ, Lin TB, Kao YL. Effect of single botulinum toxin A injection to the external urethral sphincter for treating detrusor external sphincter dyssynergia in spinal cord injury. J Rehabil Med. 2008;40:744–8.

    Article  PubMed  Google Scholar 

  55. Del Popolo G, Filocamo MT, Li Marzi V, Macchiarella A, Cecconi F, Lombardi G, et al. Neurogenic detrusor overactivity treated with english botulinum toxin a: 8-year experience of one single centre. Eur Urol. 2008;53:1013–19.

    Article  PubMed  Google Scholar 

  56. Tow AM, Toh KL, Chan SP, Consigliere D. Botulinum toxin type A for refractory neurogenic detrusor overactivity in spinal cord injured patients in Singapore. Ann Acad Med Singap. 2007;36:11–7.

    Article  PubMed  Google Scholar 

  57. Patki PS, Hamid R, Arumugam K, Shah PJ, Craggs M. Botulinum toxin-type A in the treatment of drug-resistant neurogenic detrusor overactivity secondary to traumatic spinal cord injury. BJU Int. 2006;98:77–82.

    Article  CAS  PubMed  Google Scholar 

  58. Klaphajone J, Kitisomprayoonkul W, Sriplakit S. Botulinum toxin type A injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions. Arch Phys Med Rehabil. 2005;86:2114–8.

    Article  PubMed  Google Scholar 

  59. Giannantoni A, Di Stasi SM, Stephen RL, Bini V, Costantini E, Porena M. Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol. 2004;172:240–3.

    Article  CAS  PubMed  Google Scholar 

  60. Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol. 2000;164:692–7.

    Article  CAS  PubMed  Google Scholar 

  61. Schurch B, Hauri D, Rodic B, Curt A, Meyer M, Rossier AB. Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol. 1996;155:1023–9.

    Article  CAS  PubMed  Google Scholar 

  62. Datta SN, Roosen A, Pullen A, Popat R, Rosenbaum TP, Elneil S, et al. Immunohistochemical expression of muscarinic receptors in the urothelium and suburothelium of neurogenic and idiopathic overactive human bladders, and changes with botulinum neurotoxin administration. J Urol. 2010;184:2578–85.

    Article  CAS  PubMed  Google Scholar 

  63. Li GP, Wang XY, Zhang Y. Efficacy and safety of onabotulinumtoxinA in patients with neurogenic detrusor overactivity caused by spinal cord injury: a systematic review and meta-analysis. Int Neurourol J. 2018;22:275–86.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hikita K, Honda M, Kawamoto B, Panagiota T, Inoue S, Hinata N, et al. Botulinum toxin type A injection for neurogenic detrusor overactivity: clinical outcome in J apanese patients. Int J Urol. 2013;20:94–9.

    Article  CAS  PubMed  Google Scholar 

  65. Stöhrer M, Blok B, Castro-Diaz D, Chartier-Kastler E, Del Popolo G, Kramer G, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 2009;56:81–8.

    Article  PubMed  Google Scholar 

  66. Schurch B, de SÈZE M, Denys P, Chartier-Kastler E, Haab F, Everaert K, et al. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol. 2005;174:196–200.

    Article  CAS  PubMed  Google Scholar 

  67. Gamé X, Castel-Lacanal E, Bentaleb Y, Thiry-Escudié I, De Boissezon X, Malavaud B, et al. Botulinum toxin A detrusor injections in patients with neurogenic detrusor overactivity significantly decrease the incidence of symptomatic urinary tract infections. Eur Urol. 2008;53:613–9.

    Article  PubMed  Google Scholar 

  68. Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford A, Davis J, et al. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol. 2005;174:977–83.

    Article  CAS  PubMed  Google Scholar 

  69. Elkelini MS, Bagli DJ, Fehlings M, Hassouna M. Effects of intravesical onabotulinumtoxinA on bladder dysfunction and autonomic dysreflexia after spinal cord injury: role of nerve growth factor. BJU Int. 2012;109:402–7.

    Article  CAS  PubMed  Google Scholar 

  70. Altaweel W, Alzyoud K. The effect of spinal cord-injury level on the outcome of neurogenic bladder treatment using OnabotulinumtoxinA. Urol Annals. 2015;7:320–4.

  71. Apostolidis A, Jacques TS, Freeman A, Kalsi V, Popat R, Gonzales G, et al. Histological changes in the urothelium and suburothelium of human overactive bladder following intradetrusor injections of botulinum neurotoxin type A for the treatment of neurogenic or idiopathic detrusor overactivity. Eur Urol. 2008;53:1245–53.

    Article  CAS  PubMed  Google Scholar 

  72. Mehta S, Hill D, Foley N, Hsieh J, Ethans K, Potter P, et al. A meta-analysis of botulinum toxin sphincteric injections in the treatment of incomplete voiding after spinal cord injury. Arch Phys Med Rehabil. 2012;93:597–603.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Saeed Vaheb, Yousef Mokary, Hamed Ghoshouni, Omid Mirmosayyeb, Elham Moases Ghaffary & Vahid Shaygannejad

  2. Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Omid Mirmosayyeb & Vahid Shaygannejad

  3. Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran

    Mohammad Yazdan Panah

Authors
  1. Saeed Vaheb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yousef Mokary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hamed Ghoshouni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omid Mirmosayyeb
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elham Moases Ghaffary
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Vahid Shaygannejad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohammad Yazdan Panah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

OM, VS and MYP were responsible for designing the review protocol. SV and MYP conducted the search. SV and EMG screened potentially eligible studies. SV and HG extracted data from included studies. HG and MYP analyzed data and interpreted results. YM, EMG, MYP wrote the entire manuscript and OM, VS, MYP reviewed and edited manuscript.

Corresponding author

Correspondence to Mohammad Yazdan Panah.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vaheb, S., Mokary, Y., Ghoshouni, H. et al. Onabotulinum toxin A improves neurogenic detrusor overactivity following spinal cord injury: a systematic review and meta-analysis. Spinal Cord 62, 285–294 (2024). https://doi.org/10.1038/s41393-024-00992-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-024-00992-9

Search

Advanced search

Quick links