Detrusor botulinum toxin A injection significantly decreased urinary tract infection in patients with traumatic spinal cord injury

Study design: The study was designed as a single-arm clinical trial. Objectives: To investigate the effect of detrusor botulinum toxin A (BoNTA) injection on urinary tract infection (UTI) in patients with spinal cord injury (SCI). Setting: The study was performed in a national rehabilitation research center of China. Methods: Between September 2010 and May 2012, 41 male inpatients with neurogenic detrusor overactivity (NDO) caused by traumatic SCI, mean age 36.0 +/- 8.8 years, duration of SCI since inclusion 21.5 +/- 17.3 months, received an injection of 300 U BoNTA into detrusor. Before and 3 months after injection, each patient kept a bladder diary, underwent video-urodynamic investigation and urine culture. All UTIs occurring in the 6 months before and the 6 months after injection were recorded. Results: Before injection, the mean number of UTI over 6 months was 1.39 +/- 1.36. After injection, the mean significantly decreased to 0.78 +/- 0.96 (P=0.023). The mean maximum detrusor pressure during filling decreased significantly in the patients of detrusor overactivity (n=24) compared with patients of normo-active detrusor (n= 17) after injection (35.4 +/- 12.2 vs 20.9 +/- 7.9 cmH(2)O, P=0.000), meantime, the decrease of UTI was significant in the former (1.29 +/- 1.21 vs 0.41 +/- 0.62 cmH(2)O, P=0.015) while no significant in the latter (1.46 +/- 1.47 vs 1.04 +/- 1.08, P=0.319). Conclusion: Detrusor BoNTA injection significantly decreased UTI in SCI patients with NDO. This effect seems to be related to the decrease of detrusor pressure.