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      How to diagnose neurogenic detrusor overactivity (NDO)

      Early diagnosis and treatment of NDO is essential to prevent irreversible changes within the urinary tract.5

      The diagnosis of NDO should include a detailed history, general and neurological physical examination and urinalysis.5–8

      Assessment of the patient’s risk factors and quality of life is also required.5 For initial management, basic diagnostic tests should be used to exclude an underlying disease.7

      For specialised management, more elaborate assessment is generally required, including imaging, endoscopy and urodynamics.7

      • Urodynamics assess filling and storage in the urinary tract and can be used for diagnosis and to direct targeted treatments.5
      • In patients with spinal cord injury, there is a high correlation between functional level of injury and urodynamic abnormalities. Unmanaged high detrusor pressure is a trigger for upper urinary tract injuries leading to deterioration of the upper urinary tract function and kidney failure.9,10
      • In patients with multiple sclerosis, urodynamic assessment should be repeated at regular intervals to optimise clinical management, reduce complications, and better enable patients to manage their condition.11

      NDO: neurogenic detrusor overactivity.

      BOTOX® is indicated for the management of bladder dysfunctions in adult patients who are not adequately managed with anticholinergics: neurogenic detrusor overactivity with urinary incontinence due to subcervical spinal cord  injury (traumatic or non-traumatic), or multiple sclerosis.12


      1. Allergan. Data on file. INT/0423/2016
      2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
      3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
      4. Allergan. Data on file. 014
      5. European Association of Urology Guidelines on Neuro-Urology. 2019. Available at: https://uroweb.org/. Accessed April 2022
      6. Abrams P et al. Incontinence: 6th Edition 2017;50
      7. Thuroff J W, Abrams P et al. EAU guidelines on urinary incontinence. Eur Urol 2011;59:387–400
      8. National Institute for Health and Care Excellence (NICE). CG148: Urinary incontinence in neurological disease. Available at: https://www.nice.org.uk/. Accessed April 2022
      9. Gerridzen R G, Thijssen A M et al. Risk Factors for Upper Tract Deterioration in Chronic Spinal Cord Injury Patients. J Urol 1992;147:416–18
      10. Reynard J M, Vass J et al. Sphincterotomy and the treatment of detrusor–sphincter dyssynergia: current status, future prospects. Spinal Cord 2003;41:1–11
      11. Ciancio S J, Mutchnik S E et al. Urodynamic pattern changes in multiple sclerosis. Urology 2001;57:239–45
      12. BOTOX® Summary of Product Characteristics. Available at: www.medicines.org.uk. Accessed April 2022

      Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.



      Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/

      Adverse events should also be reported to AbbVie on [email protected] 


      Date of preparation: April 2022. UK-BUO-220032.