Botulinum A Toxin Treatment for Detrusor-Sphincter Dyssynergia in Spinal Cord Disease

Petit, H; Wiart, L.; Gaujard, E.; Breton, F. Le; Ferrière, Jean-Marie; Lagueny, A; Joseph, PA; Barat, M.

doi:10.1097/00005392-199812010-00136

Cited by 17 publications

(22 citation statements)

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“…Studies comparing the success of sphincterotomy, either as an irreversible surgical procedure or as a reversible treatment with botulinum toxin A injection [9] or placement of urethral stents [10] , have used variable outcome criteria. Reduction of residual urine has frequently been used for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

et al. 2009

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Objective: Sphincterotomy is a well-established therapeutic option in male patients with neurogenic bladder dysfunction and detrusor-sphincter-dyssynergia due to spinal cord lesions. Indication and prediction of treatment outcome, however, are mainly based on clinical parameters. We analyzed the clinical usefulness of preoperative urodynamic evaluation for the prediction of success in patients undergoing external sphincterotomy. Materials and Methods: In a retrospective study, residual urine, retrograde perfusion pressure (RESP) and detrusor leak point pressure (DLPP) in 62 male patients with spinal cord injury were assessed before sphincterotomy. Data were compared to surgical success evaluated by postoperative DLPP and residual urine. Results: Sphincterotomy was successful in 85.4% of our patients. In multivariate analysis, both preoperative DLPP and RESP were superior to measurement of residual urine concerning prediction of surgical success. However, these differences were not statistically significant. Conclusion: To our knowledge, this is the first study to evaluate preoperative predictors for surgical success in patients undergoing sphincterotomy. Although urodynamic evaluation is strongly advised prior to surgery in patients with spinal cord lesions, it improves prediction of success only marginally.

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Section: Discussionmentioning

confidence: 99%

Preoperative Urodynamic Assessment in Patients with Spinal Cord Lesions Undergoing Sphincterotomy: Is Success Predictable?

et al. 2009

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“…Thus, botulinum-A toxin has been used to treat neurogenic detrusor overactivity, DSD, and motosensory urge. When the toxin is injected transurethrally or transperineally, it deceases EUS amplitude, voiding pressure, and postvoid residual volume (106,272). In 2000, botulinum-A toxin was first used to treat neurogenic bladder hyperactivity in spinal cord injured patients by injection into the bladder detrusor (303).…”

Section: Detrusor-sphincter Dyssynergiamentioning

confidence: 99%

Autonomic Consequences of Spinal Cord Injury

Hou

Rabchevsky

2014

Comprehensive Physiology

179

112

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Spinal cord injury (SCI) results not only in motor and sensory deficits but also in autonomic dysfunctions. The disruption of connections between higher brain centers and the spinal cord, or the impaired autonomic nervous system itself, manifests a broad range of autonomic abnormalities. This includes compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. These disabilities evoke potentially life-threatening symptoms that severely interfere with the daily living of those with SCI. In particular, high thoracic or cervical SCI often causes disordered hemodynamics due to deregulated sympathetic outflow. Episodic hypertension associated with autonomic dysreflexia develops as a result of massive sympathetic discharge often triggered by unpleasant visceral or sensory stimuli below the injury level. In the pelvic floor, bladder and urethral dysfunctions are classified according to upper motor neuron versus lower motor neuron injuries; this is dependent on the level of lesion. Most impairments of the lower urinary tract manifest in two interrelated complications: bladder storage and emptying. Inadequate or excessive detrusor and sphincter functions as well as detrusor-sphincter dyssynergia are examples of micturition abnormalities stemming from SCI. Gastrointestinal motility disorders in spinal cord injured-individuals are comprised of gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract. As a critical consequence of SCI, neurogenic bowel dysfunction exhibits constipation and/or incontinence. Thus, it is essential to recognize neural mechanisms and pathophysiology underlying various complications of autonomic dysfunctions after SCI. This overview provides both vital information for better understanding these disorders and guides to pursue novel therapeutic approaches to alleviate secondary complications.

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“…The dyssynergia is abolished for a few months, necessitating repeat injections. The efficacy of this treatment is high and there are few adverse effects (148)(149)(150).…”

Section: 36mentioning

confidence: 99%