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.

Onabotulinum toxin injection in neurogenic detrusor overactivity: intradetrusor versus suburothelial

We read with interest the article ‘Intradetrusor versus suburothelial onabotulinum toxin A injections for neurogenic detrusor overactivity: a pilot study’ published in Spinal Cord by Krhut et al.1 The authors need to be commended for undertaking one of the first randomized controlled studies to compare intradetrusor versus suburothelial injections of onabotulinum toxin A. We have a few comments regarding this study.

The authors describe using International Units (IU) of onabotulinum toxin. We understand that onabotulinum toxin is not dispensed in IU; rather it is marketed as Allergan Units (U) (http://www.medicines.org.uk/EMC/medicine/112/SPC/BOTOX+100+Units/). A review article in European Urology also uses U when discussing dosage.2 We feel that U rather than IU should be used for the purpose of standardization.

The authors also describe the injection technique very well using ultrasound measurement of bladder wall thickness. While there is evidence to suggest extravesical spread in association with botulinum toxin injections, we feel that in practice it is very difficult be certain clinically that all injections have been undertaken into the detrusor or suburothelially. Consequently, it is difficult to base the results on this variation. Indeed, due to this uncertainty, this aspect was not commented upon in the recent review by Mangera et al.2

Finally, we are not sure why the authors recommend suburothelial injections when they conclude that the results are not different between the two groups and that there is better detrusor compliance in the intradetrusor group.

References

  1. 1

    Krhut J, Samal V, Nemec D, Zvara P . Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study. Spinal Cord 2012; 50: 904–907.

    CAS  Article  Google Scholar 

  2. 2

    Mangera A, Andersson KE, Apostolidis A, Chapple C, Dasgupta P, Giannantoni A et al. Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA). Eur Urol 2011; 60: 784–795.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to J R Burki.

Ethics declarations

Competing interests

First author declares no conflict of interest. The second author has been a consultant for Allergan and an invited lecturer for Pfizer, Astellas and Wellspect Healthcare (formerly Astra Tech).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Burki, J., Hamid, R. Onabotulinum toxin injection in neurogenic detrusor overactivity: intradetrusor versus suburothelial. Spinal Cord 51, 725 (2013). https://doi.org/10.1038/sc.2013.62

Download citation

Further reading

Search

Quick links