Arterial hypertension related to the injection of onabotulinumtoxinA in the detrusor

Abstract

Objective and importance:

We want to report on a first case reported of a 50-year-old female with repetitive and clinical significant hypertension after each injection of onabotulinumtoxinA. This is a retrospective chart review and prospective evaluation of the natriuresis and blood pressure at baseline and after injection therapy. The aim was to explore the mechanism of action of this apparent onabotulinumtoxinA related hypertension.

Case presentation:

Retrospectively hypertension appeared after 7 days and vanished after 4–5 months following injection of 300 units of onabotulinumtoxinA in the detrusor, bladder symptoms disappeared after 2 weeks and reoccurred after 5 months. Urological, nephrological, cardiological and endocrinological evaluations were normal.

Intervention:

In the prospective evaluation a 3-day bladder diary at baseline revealed a bladder capacity of 131±57 ml and at 1 month when full effect was experienced 173±50 ml. At 1 month there were no leakages with six episodes of intermittent catheterization per day. The 24-hour blood pressure registration demonstrated the onset of hypertension at day 7 together with a reversal of the urinary sodium/creatinine ratios on the renal function profile.

Conclusion:

The increasing natriuresis coinciding with the hypertension is a normal compensatory mechanism suggesting that the hypertension has a central cause rather than it is caused by haematogenous spreading

Keywords:

• OnabotulinumtoxinA
• Hypertension
• Incontinence
• Kidney function
• Overactive bladder syndrome

Acknowledgements

All three authors actively contributed to the conception of the prospective part of the study and the scientific content of this publication and participated in the writing and reviewing of the text.