Effectiveness of Urethral Injection of Botulinum A Toxin in the Treatment of Voiding Dysfunction after Radical Hysterectomy

Kuo, Hann‐Chorng

doi:10.1159/000087803

Cited by 29 publications

(21 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, based on our previous study of therapeutic results of onabotulinumtoxinA on detrusor underactivity due to radical hysterectomy19, an improvement of quality of life index (the score was from 0–6, similar with the PPBC used in this trial) from 4.5 ± 2.7 vs. 2.3 ± 2.3 points (p = 0.000) after treatment was noted. The effect size was estimated to be 0.5 and the desired power of the trial was 0.8, at a significant level of 0.05, a total sample size of 64 was adequate.…”

Section: Methodsmentioning

confidence: 55%

OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction – A Randomized, Double-Blind, Placebo-Controlled Study

Jiang

Wang

Kuo

2016

Sci Rep

Self Cite

View full text Add to dashboard Cite

Non-neurogenic voiding dysfunction including dysfunctional voiding and detrusor underactivity caused by a spastic or non-relaxing external urethral sphincter can theoretically be treated by injections of botulinum A toxin into the external urethral sphincter. This randomized, double-blind, placebo-controlled trial was designed to determine the clinical efficacy of onabotulinumtoxinA urethral sphincter injections in patients with dysfunctional voiding or detrusor underactivity. Patients with medically refractory dysfunctional voiding (n = 31) or detrusor underactivity (n = 31) were randomly allocated in a 2:1 ratio to receive either onabotulinumtoxinA (100 U) (n = 38) or placebo (normal saline) (n = 24). There were no significant differences in subjective or objective parameters between patients who received onabotulinumtoxinA and those who received saline injection therapy, and the overall success rate was 43.5% (reduction in Patient perception of Bladder Condition by ≥2: onabotulinumtoxinA 36.8% vs placebo 54.2%, p = 0.114). The results were similar between the dysfunctional voiding and detrusor underactivity subgroups; however, a significant reduction in detrusor voiding pressure was only observed in dysfunctional voiding patients who received onabotulinumtoxinA. Repeat urethral sphincter onabotulinumtoxinA injections offered greater therapeutic effects in both dysfunctional voiding and detrusor underactivity patients. For patients with non-neurogenic voiding dysfunction, the success rate of onabotulinumtoxinA urethral sphincter injection was not superior to placebo.

show abstract

Section: Methodsmentioning

confidence: 55%

OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction – A Randomized, Double-Blind, Placebo-Controlled Study

Jiang

Wang

Kuo

2016

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Good therapeutic results were further confirmed by several small cohort studies with doses of 50 U and 100 U BoNT-A [41921]. Other indications include voiding dysfunction due to urethral overactivity, dysfunctional voiding, idiopathic detrusor underactivity, detrusor areflexia caused by cauda equina lesions, and peripheral neuropathy [51322]. In some patients with idiopathic detrusor underactivity, recovery of detru-sor contractility was noted after urethral BoNT-A injections.…”

Section: Bont-a Urethral Injection For Treatment Of Nonneurogenic mentioning

confidence: 94%

“…One study evaluated the effectiveness of urethral injection of BoNT-A in treating voiding dysfunction in these patients [22]. Thirty patients with difficult urination after radical hysterectomy for cervical cancer received urethral injection of 100 U of BoNT-A ( n = 20) or medical treatment as controls ( n = 10).…”

Section: Effectiveness Of Bont-a Urethral Injection In Treatment Omentioning

confidence: 99%

Botulinun A toxin urethral sphincter injection for neurogenic or nonneurogenic voiding dysfunction

Kuo

2016

Tzu Chi Medical Journal

Self Cite

View full text Add to dashboard Cite

Voiding dysfunction due to detrusor underactivity or urethral sphincter dysfunction is a treatment challenge for urologists. Recently, urologists have used botulinum toxin A (BoNT-A) injection into the urethral sphincter to treat voiding dysfunction. This treatment has been found to decrease urethral pressure and postvoid residual volume, and increase voiding efficiency in patients with neurogenic detrusor sphincter dyssynergia, nonneurogenic dysfunctional voiding, and detrusor underactivity. Although not all patients can achieve excellent therapeutic outcomes, patients with idiopathic detrusor underactivity might have recovery of detrusor contractility after urethral sphincter BoNT-A injection. However, urinary incontinence might be a de novo adverse event after treatment. Repeat urethral injection is necessary to maintain therapeutic efficacy. Patients should be fully informed of the limited therapeutic efficacy and possible adverse events prior to treatment. This article reviews recent studies of urethral sphincter BoNT-A treatment for voiding dysfunction.

show abstract

“…50,51 Other indications include voiding dysfunction owing to urethral overactivity, dysfunctional voiding, idiopathic detrusor underactivity, cauda equina lesions and peripheral neuropathy. 5,52 Interestingly, in a small study of patients with idio pathic low detrusor contractility and voiding dysfunc tion, detrusor contractions recovered in 13 of 27 patients (48%) after urethral BoNTA injections; five of these patients had longterm improvements for more than 1 year without requiring repeat injections. 53 The primary causes of failed BoNTA treatment were low detrusor contractility, very low abdominal straining pressure, a tight urethral sphincter, psychological inhibition of voiding and bladder neck obstruction.…”

Section: Voiding Dysfunctionmentioning

confidence: 99%

Current and potential urological applications of botulinum toxin A

Jiang

Liao

2015

Nat Rev Urol

Self Cite

View full text Add to dashboard Cite

Botulinum toxin subtype A (BoNT-A) is a potent neurotoxin that can selectively modulate neurotransmitter release from nerve endings, resulting in muscular paralysis. BoNT-A might also act on sensory nerves, and have an anti-inflammatory effect. In the first urological use of BoNT-A, injection into the urethral sphincters of patients with detrusor-sphincter dyssynergia resulted in a reduction of urethral resistance and improved voiding efficiency. Subsequently, intravesical BoNT-A injections have received regulatory approval for treatment of neurogenic detrusor overactivity owing to spinal cord lesions or multiple sclerosis, and idiopathic overactive bladder in adults. BoNT-A has also been widely used to treat patients with the off-label indications of neurogenic or non-neurogenic voiding dysfunction and male lower urinary tract symptoms owing to BPH and bladder-neck dysfunction. Other indications for which urologists have applied BoNT-A injections include interstitial cystitis/bladder pain syndrome, bladder oversensitivity and chronic pelvic pain syndrome. BoNT-A is currently delivered as an intravesical injection; however, use of liposome encapsulated formulations is also beginning to show some therapeutic potential.

show abstract

Effectiveness of Urethral Injection of Botulinum A Toxin in the Treatment of Voiding Dysfunction after Radical Hysterectomy

Cited by 29 publications

References 19 publications

OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction – A Randomized, Double-Blind, Placebo-Controlled Study

OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction – A Randomized, Double-Blind, Placebo-Controlled Study

Botulinun A toxin urethral sphincter injection for neurogenic or nonneurogenic voiding dysfunction

Current and potential urological applications of botulinum toxin A

Contact Info

Product

Resources

About