Impact of the suspension of neurogenic detrusor overactivity treatment with botulinum toxin due to the COVID-19 pandemic

Introduction: The COVID-19 pandemic has imposed an additional pressure on health systems worldwide. Patients with neurogenic detrusor overactivity (NDO) were especially vulnerable to inadequate care. This study aims to evaluate the impact of the suspension of NDO treatment with Botulinum Toxin (BONT-A) due to the COVID-19 pandemic.

Methods: Cross-sectional study of patients with spinal cord injury and NDO, who underwent BONT-A treatment in 2018 or 2019 and, whose administration programed for 2020 or 2021 was suspended. The study protocol was divided into two parts. Phase 1 consisted of data collection from the clinical processes and in phase 2 a standardized telephone questionnaire was applied. Information was collected at 3 time points: (1) before the last BONT-A treatment, (2) after the last BONT-A treatment and (3) at the time of the telephone call. Statistical analysis used the McNemar and the Wilcoxon test with a p-value ⩽ 0.05 as level of significance.

Results: 21 patients with mean age of 42.0 years and disease duration of 16.9 years were included. On average patients were undergoing treatment with BONT-A for 7.6 years and mean inter-treatment frequency was 2.3 years. Mean time since the last BONT-A administration was 2.3 years and mean reported BONT-A effect duration was 11.9 months. A significant increase in the percentage of patients with involuntary urinary loss (p = 0.004) and urgency (p = 0.031) was found. A significant decrease in mean catheterization interval from 4.5 to 3.6 h (p = 0.002) and an increase in daily oxybutynin dosage from 8.5 to 12.1 mg (p = 0.002) was also found.

Discussion: The COVID-19 pandemic originated clinical worsening of patients undergoing regular BONT-A treatment for NDO. These patients presented a significant increase in involuntary urinary loss, urgency and medication dosage and a decrease in catheterization interval. Thus, interruption of intravesical BONT-A treatment severely affected these patients and needs to be avoided.