Patients' perspective of botulinum toxin-A as a long-term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury.

Objective: To evaluate patients' perspective on whether they would consider botulinum toxin-A (BTX-A) injections as a long-term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI).
Patients and Methods: In all, 72 patients with SCI and urodynamically confirmed NDO refractory to anticholinergics, who have had at least one or more injections with BTX-A were invited to participate in a 5-min telephone questionnaire covering various aspects of their treatment. Questions about patient satisfaction were rated on a scale from 1 to 10 (1, not satisfied; to 10, very satisfied).
Results: Of the 72 patients surveyed, 48 (67%) were still actively undergoing repeat BTX-A injections. The mean patient satisfaction score was 6.2. Of the 48 patients, 43 (90%) replied that they would consider continuing with BTX-A injections as a long-term treatment option. Only seven (15%) of patients still having BTX-A injections would consider an alternative permanent surgical option in the next 5 years. Of those patients considering a one-off permanent surgical solution, younger patients were likely to consider this at a later interval than those in an older group (Spearman's correlation coefficient, -0.52, 95% confidence interval -0.78 to -0.10, P = 0.02). The annual new patient recruitment rate was high (mean 14.4) and the annual withdrawal rate was low (mean 4.8).
Conclusion: With high satisfaction and low annual withdrawal rates, there are increasingly many patients on BTX-A. Most consider continuing BTX-A injections in the long term, increasing the future demand for this service. There is an urgent need for further research into optimizing the current delivery of an intradetrusor BTX-A injection service for patients with NDO.