Thomas Kessler, University of Zuerich, Universitätshospital Balgrist, Spinal Cord Injury Center & Research, Zuerich, Switzerland

Neurogenic detrusor overactivity due to spinal cord injury and botulinum neurotoxin type A injections into the detrusor: A structural and functional magnetic resonance imaging study on supraspinal lower urinary tract control

Funded in: 2013, 2014, 2015

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Problem: The complex supraspinal network, that controls lower urinary tract function, is not well understood

Target: Supraspinal control of the lower urinary tract with Botulinum Neurotoxin A using structural and functional MRI

Goal: Unlock the function of supraspinal centres to develop new therapeutic strategies for the lower urinary tract control


Spinal cord injury affects not only locomotion and the sensory system of the body below the lesionbut also affects the autonomic nervous system. Thus, most SCI patients suffer from lower urinary tract symptoms, which have a negative impact on the patients’ health related quality of life.  The control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous systems. A complex supraspinal network, that is not completely understood so far, controls lower urinary tract function.

Botulinum Neurotoxin A (BoNTA) injections into the detrusor muscle of the bladder have become a well-established and widely accepted therapy for neurogenic detrusor overactivity. BoNTA injections into the detrusor are highly effective, minimally invasive, and generally well tolerated. Despite the popularity of this treatment, the exact mechanism of action remains to be elucidated. BoNTA exerts its direct efferent effect by blocking temporary the innervation of the detrusor muscle, but an additional effect on the areas in the brain involved in bladder control may contribute to the effect.

The objective of the project is to investigate the supraspinal control of the lower urinary tract in healthy volunteers and in SCI patients with neurogenic detrusor overactivity before and after treatment with BoNTA using structural and functional MRI.

In this prospective neuroimaging study, 24 SCI patients with neurogenic detrusor overactivity will be assessed pre and post BoNTA intradetrusor injections. They will be compared to 12 age- and sex-matched healthy control subjects, which will also be scanned and clinically assessed. This project has great potential to reveal essential findings providing more precise information about the involvement and function of supraspinal centres relevant for lower urinary tract control.