Onabotulinum toxin A for the treatment of neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis.

Evidence for the efficacy and safety of intravesical onabotulinum toxin A (onabotA) injections has led to it being licensed in many countries in patients with urinary incontinence due to neurogenic detrusor overactivity resulting from spinal cord injury and multiple sclerosis, who are refractory or intolerant to the gold-standard treatment, anticholinergics. Owing to its mechanism of action, an inhibitory effect on acetylcholine release is obtained for up to 10 months, with a recommended dose of 200 units. Urinary tract infections and postvoid residual volume are the most prevalent side effects. In the case of residual volume, clean intermittent catheterization might be necessary. In patients with spinal cord injury and multiple sclerosis, it is recommended to evaluate the manual dexterity and cognitive function before onabotA injections, to ensure that the patient and caregiver are able to perform catheterization if necessary. OnabotA treatment has a beneficial effect not only on urinary symptoms but also on quality of life.