Botulinum-A Toxin as a Treatment of Detruosor-Sphincter Dyssynergia: A Prospective Study in 24 Spinal Cord Injury Patients

Abstract

Although costly, botulinum-A toxin injections, which aim at suppressing detrusor-sphincter dyssynergia but not bladder neck dyssynergia, appear to be a valid alternative for patients who do not desire surgery or are unable to perform self-catheterization.

Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease

“…9,11 This duration of action was the same as that of BTx in its other indications, 6,7 the transitoriness of the e ect being due to synaptic regrowth after injection. 7 However, in two patients in our series, the clinical e ect lasted beyond the usual duration of action of BTx, which might signify a more durable modi®cation of the re¯ex status and urethral behaviour.…”

“…Schurch reported no side e ects. 11 We did not note the e ects reported by Dykstra (transitory paresis of the limbs, transitory exacerbation of Figure 1 PRUV 1 month after treatment in the group of patients whose initial PRUV was higher than 300 ml. PRUV: postvoiding residual urine volume after treatment Figure 2 PRUV 1 month after treatment in the group of patients whose initial PRUV was between 100 and 300 ml.…”

“…Another factor contributing to failure appeared, to us, to be poor bladder contractility (three cases), in accordance with the results of Schurch. 11 Indeed, in spite of the diminution in DSD and urethral hypertonia after treatment with BTx, a low level of bladder contractility most probably does not permit improvement of bladder emptying. Another factor of failure reported by Schurch 11 was the presence of bladder neck dyssynergia, a parameter that was not quanti®ed in our trial.…”

“…6,7 It was ®rst evaluated as a treatment for DSD by Dykstra et al 8,9 in 16 patients, then by Schurch et al 10,11 in 24 patients. These studies showed that BTx relaxes the external urethral sphincter (EUS) and reduces DSD in approximately 80% of cases.…”

Botulinumtoxin in der Urologie

“…Zugang (de Seze et al, 2002;Dykstra et al, 1988;Gallien et al, 2005;Gallien et al, 1998;Jost, 2006;Schurch et al, 1996) oder über eine -von Urologen favorisiertetransurethrale Technik unter Sicht (Abb. 6.3.)…”