A PILOT STUDY ASSESSING THE FEASIBILITY AND EFFECTIVENESS OF AMNIOTIC BLADDER THERAPY IN PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY

Wednesday, November 1, 2023

12:50 PM – 12:56 PM

Location: Station 4

Presenting Author(s)

Lincoln D. Erickson, MD (he/him/his)

Physical Medicine and Rehabilitation, MD, PGY2
Rehabilitation Institute of Michigan
Royal Oak, Michigan, United States

Non-presenting Author(s)

ND

Nivedita Dhar, MD

urology attending
Detroit VA
Bloomfield hills, Michigan, United States
DP

David Perlman

Resident
Wayne State University, United States
DK

Dylan Kato

Medical Student
Wayne State University School of Medicine, United States
EM

Erin McCarty, MD

Attending Physician
Rehabilitation Institute of Michigan
Detroit, Michigan, United States
MB

Michael Bush-Arnold, MD

Attending, Spinal Cord Injury unit
Rehabilitation Institute of Michigan
Detroit, Michigan, United States
AB

Ali Bitar, MD

CMO
Rehabilitation Institute of Michigan
Detroit, Michigan, United States
SW

Sophie Wittenberg

Medical Student
Wayne State University School of Medicine
Petoskey, Michigan, United States
NP

Nicholas Pryde

Medical Student
WSUSOM, United States

Research Objectives: Research

Objective: To evaluate the use of amniotic bladder therapy (ABT) in the management of neurogenic detrusor overactivity (NDO) specifically in patients with spinal cord injury (SCI).

Design: Retrospective study

Setting: Referral Center

Participants: Consecutive NDO patients who experienced involuntary detrusor contractions near or at the maximum cystometric capacity (MCC), failed previous treatment modalities including oral and intra-vesical therapies, had traumatic spinal cord injury above T6, and were using intermittent catheterizations to empty the bladder.

Interventions: Intra-detrusor injection of 100mg micronized amniotic membrane (Clarix Flo) diluted in 10ml 0.9% preservative-free sodium chloride under general anesthesia.

Main Outcome Measures: Qualiveen questionnaire, maximum detrusor pressure (MDP), MCC, and frequency of autonomic dysreflexia (AD) were assessed.

Results: Eight consecutive patients with an average age of 39.6 ± 13.6 years were included. After ABT, there was a significant decrease in the severity of urinary tract symptoms based on the Qualiveen questionnaire: 3.9 ± 0.17 at baseline to 2.9 ± 0.21 at 2 weeks, 2.1 ± 0.53 at 4 weeks, 1.4 ± 0.20 at 8 weeks, 1.4 ± 0.05 at 3 months, 1.3 ± 0.05 at 4 months, and 1.4 ± 0.10 at 5 months. This was associated with an increase in maximum MCC from 208.63 ± 34.98 mL before treatment to 430.25 ± 32.4 mL at 4 weeks and 427.25 ± 24.9 mL at 3 months. MDP decreased from 67.38 ± 2.88 cmH2O to 33 ± 1.2 cmH2O and 33.38 ± 1.85 cmH2O at similar timepoints. All patients reported no AD episodes at 3 to 5 months, despite experiencing daily or every other day before treatment.

Conclusions: ABT appears to be a promising option for NDO in SCI patients by improving both quantitative and qualitative aspects of their lives. Further studies are warranted.

Author(s) Disclosures: The authors have no relevant conflict of interests to disclose

Learning Objectives:

Upon completion, participants will be able to evaluate the use of amniotic bladder therapy (ABT) in management of neurogenic detrusor overactivity (NDO) specifically in patients with spinal cord injury (SCI).
Upon completion, participants will be able to propose future studies using this pilot study as a foundational approach.
Upon completion, participants will be able to question the current management of NDO in SCI patients
upon completion, participants will be able to discover how this pilot treatment improves these patients' quality and quantitative aspects of their life.