{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T07:09:25Z","timestamp":1783753765846,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005925","name":"Buddhist Tzu Chi Medical Foundation","doi-asserted-by":"publisher","award":["TCMF-MP 110-03-01"],"award-info":[{"award-number":["TCMF-MP 110-03-01"]}],"id":[{"id":"10.13039\/501100005925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005925","name":"Buddhist Tzu Chi Medical Foundation","doi-asserted-by":"publisher","award":["112-S0151"],"award-info":[{"award-number":["112-S0151"]}],"id":[{"id":"10.13039\/501100005925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005925","name":"Buddhist Tzu Chi Medical Foundation","doi-asserted-by":"publisher","award":["109-2314-B-002-173-MY3"],"award-info":[{"award-number":["109-2314-B-002-173-MY3"]}],"id":[{"id":"10.13039\/501100005925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["TCMF-MP 110-03-01"],"award-info":[{"award-number":["TCMF-MP 110-03-01"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["112-S0151"],"award-info":[{"award-number":["112-S0151"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005762","name":"National Taiwan University Hospital","doi-asserted-by":"publisher","award":["109-2314-B-002-173-MY3"],"award-info":[{"award-number":["109-2314-B-002-173-MY3"]}],"id":[{"id":"10.13039\/501100005762","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Science and Technology Council","award":["TCMF-MP 110-03-01"],"award-info":[{"award-number":["TCMF-MP 110-03-01"]}]},{"name":"National Science and Technology Council","award":["112-S0151"],"award-info":[{"award-number":["112-S0151"]}]},{"name":"National Science and Technology Council","award":["109-2314-B-002-173-MY3"],"award-info":[{"award-number":["109-2314-B-002-173-MY3"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Spinal cord injuries (SCI) have a profound impact on autonomic systems, sometimes resulting in multi-organ dysfunction, including of the neurogenic bladder. Autonomic dysreflexia (AD) is commonly seen in patients with SCI above T6 when the injured cord develops a deregulated sympathetic reflex, which can be induced by bladder sensation and can cause hypertensive crisis. While intravesical injection of botulinum toxin A (Botox) is a standard therapy for neurogenic detrusor overactivity, the role of Botox for AD has rarely been described. This study reviewed the medical records of SCI patients who reported AD and received either detrusor or urethral sphincter injection with Botox. The primary endpoint is the subjective improvement of AD. The secondary endpoint is a change in videourodynamic parameters before and after Botox injection. A total of 200 patients were enrolled for analysis. There were 125 (62.5%) patients in the detrusor injection group, and 75 (37.5%) in the urethral sphincter injection group. There were 79 (63.2%) patients in the detrusor injection group and 43 (57.3%) in the urethral sphincter injection group reporting moderate or marked improvement. Detrusor injection leads to a greater improvement in AD, probably because of decreased detrusor pressure and increased compliance after Botox injection. Urethral sphincter injection appears to have a modest effect on AD, despite general improvements in the voiding parameters of videourodynamic study.<\/jats:p>","DOI":"10.3390\/toxins15020108","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T03:05:14Z","timestamp":1674702314000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Botulinum Toxin A Injection for Autonomic Dysreflexia\u2014Detrusor Injection or Urethral Sphincter Injection?"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3183-1830","authenticated-orcid":false,"given":"Po-Ming","family":"Chow","sequence":"first","affiliation":[{"name":"Department of Urology, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei 100225, Taiwan"},{"name":"Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-4771","authenticated-orcid":false,"given":"Hann-Chorng","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Sec. 3, Chung-Yang Rd., Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1038\/sj.sc.3100422","article-title":"A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients","volume":"35","author":"Moore","year":"1997","journal-title":"Spinal Cord"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2236","DOI":"10.1001\/jama.2015.6250","article-title":"Traumatic Spinal Cord Injury in the United States, 1993-2012","volume":"313","author":"Jain","year":"2015","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1038\/sc.2011.178","article-title":"Epidemiology of traumatic spinal cord injury: Trends and future implications","volume":"50","author":"Devivo","year":"2012","journal-title":"Spinal Cord"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1016\/S0003-9993(99)90251-4","article-title":"Long-term medical complications after traumatic spinal cord injury: A regional model systems analysis","volume":"80","author":"McKinley","year":"1999","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1136\/jnnp.2009.178798","article-title":"Mortality after traumatic spinal cord injury: 50 years of follow-up","volume":"81","author":"Hagen","year":"2009","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1016\/j.juro.2012.10.013","article-title":"Acute Spinal Cord Injury\u2014Do Ambulatory Patients Need Urodynamic Investigations?","volume":"189","author":"Bellucci","year":"2013","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00345-018-2301-z","article-title":"Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury","volume":"36","author":"Hamid","year":"2018","journal-title":"World J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1038\/nrurol.2016.206","article-title":"The management of neurogenic lower urinary tract dysfunction after spinal cord injury","volume":"13","author":"Wyndaele","year":"2016","journal-title":"Nat. Rev. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.autneu.2017.05.002","article-title":"Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management","volume":"209","author":"Eldahan","year":"2017","journal-title":"Auton. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/014107680309600711","article-title":"Tripling of Blood Pressure by Sexual Stimulation in a Man with Spinal Cord Injury","volume":"96","author":"McBride","year":"2003","journal-title":"J. R. Soc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.juro.2016.04.046","article-title":"Long-Term Efficacy and Safety of OnabotulinumtoxinA in Patients with Neurogenic Detrusor Overactivity Who Completed 4 Years of Treatment","volume":"196","author":"Rovner","year":"2016","journal-title":"J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lee, Y.-K., and Kuo, H.-C. (2019). Therapeutic Effects of Botulinum Toxin A, via Urethral Sphincter Injection on Voiding Dysfunction Due to Different Bladder and Urethral Sphincter Dysfunctions. Toxins, 11.","DOI":"10.3390\/toxins11090487"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/S0022-5347(05)67283-7","article-title":"Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: A new alternative to anticholinergic drugs? Preliminary results","volume":"164","author":"Schurch","year":"2000","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1089\/neu.2015.4278","article-title":"Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury","volume":"33","author":"Fougere","year":"2016","journal-title":"J. Neurotrauma"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/sj.sc.3100638","article-title":"Long-term survival in spinal cord injury: A fifty year investigation","volume":"36","author":"Frankel","year":"1998","journal-title":"Spinal Cord"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s10286-015-0303-0","article-title":"Prevention of recurrent autonomic dysreflexia: A survey of current practice","volume":"25","author":"Caruso","year":"2015","journal-title":"Clin Auton Res"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.apmr.2008.10.017","article-title":"A Systematic Review of the Management of Autonomic Dysreflexia After Spinal Cord Injury","volume":"90","author":"Krassioukov","year":"2009","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1089\/neu.2014.3590","article-title":"Selective Alpha Adrenergic Antagonist Reduces Severity of Transient Hypertension during Sexual Stimulation after Spinal Cord Injury","volume":"32","author":"Phillips","year":"2015","journal-title":"J. Neurotrauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S0079-6123(05)52017-X","article-title":"Segmental organization of spinal reflexes mediating autonomic dysreflexia after spinal cord injury","volume":"152","author":"Rabchevsky","year":"2006","journal-title":"Prog. Brain Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0079-6123(05)52002-8","article-title":"Spinal sympathetic interneurons: Their identification and roles after spinal cord injury","volume":"152","author":"Schramm","year":"2006","journal-title":"Prog. Brain. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.neuroscience.2008.12.022","article-title":"Intraspinal sprouting of unmyelinated pelvic afferents after complete spinal cord injury is correlated with autonomic dysreflexia induced by visceral pain","volume":"159","author":"Hou","year":"2009","journal-title":"Neuroscience"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1089\/089771502762300193","article-title":"Sensitivity of Sympathetically Correlated Spinal Interneurons, Renal Sympathetic Nerve Activity, and Arterial Pressure to Somatic and Visceral Stimuli after Chronic Spinal Injury","volume":"19","author":"Krassioukov","year":"2002","journal-title":"J. Neurotrauma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"jrm00264","DOI":"10.2340\/jrm.v54.122","article-title":"Concomitant Detrusor and External Urethral Sphincter Botulinum Toxin-A Injections in Male Spinal Cord Injury Patients with Detrusor Overactivity and Detrusor Sphincter Dyssynergia","volume":"54","author":"Chen","year":"2022","journal-title":"J. Rehabil. Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Jhang, J.-F. (2019). Using Botulinum Toxin A for Treatment of Interstitial Cystitis\/Bladder Pain Syndrome\u2014Possible Pathomechanisms and Practical Issues. Toxins, 11.","DOI":"10.3390\/toxins11110641"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1097\/01.ju.0000169481.42259.54","article-title":"Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity","volume":"174","author":"Apostolidis","year":"2005","journal-title":"J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1007\/s00192-020-04333-1","article-title":"Obstructive patterns in videourodynamic studies predict responses of female dysfunctional voiding treated with or without urethral botulinum toxin injection: A long-term follow-up study","volume":"31","author":"Chow","year":"2020","journal-title":"Int. Urogynecol. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/nau.22395","article-title":"The Therapeutic Effects of Repeated Detrusor Injections Between 200 or 300 Units of OnabotulinumtoxinA in Chronic Spinal Cord Injured Patients","volume":"33","author":"Chen","year":"2014","journal-title":"Neurourol. Urodyn."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"23242","DOI":"10.1038\/s41598-021-02617-0","article-title":"Identifying occult bladder outlet obstruction in women with detrusor-underactivity-like urodynamic profiles","volume":"11","author":"Chow","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1007\/s11255-022-03265-7","article-title":"Performance of urinary biomarkers in differentiating dysfunctional voiding in women with overactive bladder syndrome: A prospective pilot study","volume":"54","author":"Chow","year":"2022","journal-title":"Int. Urol. Nephrol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.urology.2005.07.014","article-title":"Responsiveness of symptom scales for interstitial cystitis","volume":"67","author":"Propert","year":"2006","journal-title":"Urology"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/15\/2\/108\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:15:54Z","timestamp":1760120154000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/15\/2\/108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,26]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["toxins15020108"],"URL":"https:\/\/doi.org\/10.3390\/toxins15020108","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,26]]}}}