AccScience Publishing / ITPS / Volume 7 / Issue 2 / DOI: 10.36922/itps.2037
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ORIGINAL RESEARCH ARTICLE

A pilot study assessing the feasibility and effectiveness of amniotic bladder therapy in patients with neurogenic detrusor overactivity

Sophie Wittenberg1 Codrut Radoiu1 Kyle O’Hollaren1 Lincoln Erikson2,3 Michael Bush-Arnold2 Ali Bitar2 Steven Lucas1,4 Nivedita Dhar3,4*
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1 Department of Urology, Wayne State University School of Medicine, Detroit, Michigan, USA
2 Rehabilitation Institute of Michigan, Detroit, Michigan, USA
3 Detroit Medical Center, Detroit, Michigan, USA
4 John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan, USA
INNOSC Theranostics and Pharmacological Sciences 2024, 7(2), 2037 https://doi.org/10.36922/itps.2037
Submitted: 14 October 2023 | Accepted: 23 November 2023 | Published: 29 February 2024
© 2024 by the Author (s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Neurogenic detrusor overactivity (NDO) is characterized by involuntary detrusor contractions that often occur following spinal cord injury (SCI). In addition, patients with SCI above T6 are at risk for autonomic dysreflexia (AD). Amniotic membranes (AM) are used for the management of wound healing in multiple medical disciplines. Thus, this study aims to evaluate the efficiency of amniotic bladder therapy (ABT) in managing NDO, specifically in patients with SCI. The patients received intra-detrusor injections under general anesthesia of 100 mg micronized AM (Clarix Flo) diluted in 10 mL 0.9% preservative-free sodium chloride. Clinical evaluations, including maximum detrusor pressure, maximum cystometric capacity, and frequency of AD, were conducted, alongside the completion of questionnaires (Qualiveen questionnaire) preoperatively and postoperatively at weeks 2, 4, 8, and 12. Eight consecutive patients with an average age of 39.6 ± 13.6 years were included. After ABT, a significant decrease in the severity of urinary tract symptoms was observed based on the Qualiveen questionnaire: 3.9 ± 0.17 at baseline to 2.9 ± 0.21 at week 2, 2.1 ± 0.53 at week 4, and 1.4 ± 0.20 at week 8 (P < 0.01). Improved clinical symptoms were associated with a decreased maximum detrusor pressure, increased maximum cystometric capacity, and reduced frequency of AD. In conclusion, we investigated ABT as a potential treatment option for NDO associated with SCI. Further investigations are warranted to validate the effectiveness of ABT in this patient population and determine treatment durability.

Keywords
Neurogenic bladder
Neurogenic detrusor overactivity
Autonomic dysreflexia
Funding
None.
Conflict of interest
The authors have no relevant conflict of interest to disclose.
References
  1. Cho SY, Yi JS, Oh SJ. The clinical significance of poor bladder compliance. Neurourol Urodyn. 2009;28:1010-1014. doi: 10.1002/nau.20713

 

  1. Tseng SC. HC-HA/PTX3 purified from amniotic membrane as novel regenerative matrix: Insight into relationship between inflammation and regeneration. Invest Ophthalmol Vis Sci. 2016;57(5):ORSFh1-ORSFh8 doi: 10.1167/iovs.15-17637

 

  1. Madan R, Radoiu C, Liaw A, Lucas S, Hamada A, Dhar N. Early three-month report of amniotic bladder therapy in patients with interstitial cystitis/bladder pain syndrome. Int Urol Nephrol. 2023;55:1937-1942. doi: 10.1007/s11255-023-03652-8

 

  1. Tseng SC, Espana EM, Kawakita T, et al. How does amniotic membrane work? Ocul Surf. 2004;2:177-187. doi: 10.1016/s1542-0124(12)70059-9

 

  1. Gajewski JB, Schurch B, Hamid R, et al. An international continence society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourol Urodyn. 2018;37:1152-1161. doi: 10.1002/nau.23397

 

  1. Tan EK, Cooke M, Mandrycky C, et al. Structural and biological comparison of cryopreserved and fresh amniotic membrane tissues. J Biomater Tissue Eng. 2014;4:379-388. doi: 10.1166/jbt.2014.1180

 

  1. Janzen J, Vuong PN, Bersch U, Michel D, Zaech GA. Bladder tissue biopsies in spinal cord injured patients: Histopathologic aspects of 61 cases. Neurourol Urodyn. 1998;17:525-530. doi: 10.1002/(sici)1520-6777(1998)17:5<525:aid-nau8>3.0.co;2-f

 

  1. Stöhrer M, Blok B, Castro-Diaz D, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 2009;56:81-88. doi: 10.1016/j.eururo.2009.04.028

 

  1. Ginsberg DA, Boone TB, Cameron AP, et al. The AUA/ SUFU guideline on adult neurogenic lower urinary tract dysfunction: Treatment and follow-up. J Urol. 2021;206:1106-1113. doi: 10.1097/JU.0000000000002239

 

  1. Jiang YH, Chen SF, Kuo HC. Frontiers in the clinical applications of botulinum toxin a as treatment for neurogenic lower urinary tract dysfunction. Int Neurourol J. 2020;24:301-312. doi: 10.5213/inj.2040354.177

 

  1. Klaphajone J, Kitisomprayoonkul W, Sriplakit S. Botulinum toxin type a injections for treating neurogenic detrusor overactivity combined with low-compliance bladder in patients with spinal cord lesions. Arch Phys Med Rehabil. 2005;86:2114-2118. doi: 10.1016/j.apmr.2005.06.008

 

  1. Wada N, Karnup S, Kadekawa K, et al. Current knowledge and novel frontiers in lower urinary tract dysfunction after spinal cord injury: Basic research perspectives. Urol Sci. 2022;33:101-113. doi: 10.4103/uros.uros_31_22

 

  1. Ferreira A, Nascimento D, Cruz CD. Molecular mechanism operating in animal models of neurogenic detrusor overactivity: A systematic review focusing on bladder dysfunction of neurogenic origin. Int J Mol Sci. 2023;24:3273. doi: 10.3390/ijms24043273

 

  1. Tseng SC. Amniotic membrane transplantation for ocular surface reconstruction. Biosci Rep. 2001;21:481-489. doi: 10.1023/a:1017995810755

 

  1. He H, Zhang S, Tighe S, Son J, Tseng SC. Immobilized heavy chain-hyaluronic acid polarizes lipopolysaccharide-activated macrophages toward M2 phenotype. J Biol Chem. 2013;288:25792-25803. doi: 10.1074/jbc.M113.479584

 

  1. Zhu YT, Li F, Zhang Y, et al. HC-HA/PTX3 purified from human amniotic membrane reverts human corneal fibroblasts and myofibroblasts to keratocytes by activating BMP signaling. Invest Ophthalmol Vis Sci. 2020;61:62. doi: 10.1167/iovs.61.5.62

 

  1. Wynn TA. Cellular and molecular mechanisms of fibrosis. J Pathol. 2008;214:199-210. doi: 10.1002/path.2277

 

  1. Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S. A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014;37:204-218. doi: 10.1002/nur.21593

 

  1. Ku JH. The management of neurogenic bladder and quality of life in spinal cord injury. BJU Int. 2006;98:739-745. doi: 10.1111/j.1464-410X.2006.06395.x

 

  1. Allen KJ, Leslie SW. Autonomic dysreflexia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.

 

  1. Linsenmeyer TA. Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review. J Spinal Cord Med. 2013;36:402-419. doi: 10.1179/2045772313Y.0000000116
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INNOSC Theranostics and Pharmacological Sciences, Electronic ISSN: 2705-0823 Print ISSN: 2705-0734, Published by AccScience Publishing