Satisfaction with urethral injection of Botulinum Toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion

Kuo, Hann‐Chorng

doi:10.1002/nau.20606

Cited by 59 publications

(77 citation statements)

References 24 publications

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“…We found excellent results in 48% of the patients, based on very strict criteria that combined objective (PVR ⩽ 100 ml and ⩽ 20%) and subjective (dysuria ⩽ 2) clinical parameters. The 6.5-month duration of effectiveness found in this study is in line with some studies, 4,7,15 whereas others found shorter durations of around 3 months. 1,8 PVR is a clinically important parameter, and it has been found to improve in all studies of botulinum toxin treatment.…”

Section: Discussionsupporting

confidence: 92%

“…2,12 The rationale for treating patients with SCI and DSD with botulinum toxin is based on the results of two placebo-controlled studies 5,6 and other open studies. 1,[4][5][6][7][8]10,[13][14][15][16] Most studies involved doses of 100 U of botulinum toxin type A (Botox, Allergan). 17 Two techniques have been described, involving endoscopic or transperineal approaches, with similar outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…18 The results for urodynamic parameters are conflicting and not necessarily correlated with clinical improvement. 17 Detrusor pressure may 7,8 or may not be improved, 1,4,5,13 detrusor leak point pressure either remains unchanged 4,13 or decreases significantly. 8 Only decreases in urethral pressure have been systematically reported.…”

Section: Discussionmentioning

confidence: 99%

“…1,[4][5][6][7][8] This treatment has been shown to be effective in 60-100% of SCI patients, with a duration of effectiveness from 3 1,8 to 6 months 4,7 and no significant side effects. Sphincteric stenting is another option with a satisfactory success rate of 75% at 3 months; however, this technique is also associated with short-and long-term complications.…”

Section: Introductionmentioning

confidence: 99%

“…Sphincteric stenting is another option with a satisfactory success rate of 75% at 3 months; however, this technique is also associated with short-and long-term complications. 9 The reasons for the failure of botulinum toxin injections are not fully understood: detrusor underactivity, 1 bladder neck dyssynergia (BND), 1,7 type of DSD and the dose or dilution of the toxin 10 have been suggested to affect effectiveness. However, few studies have been carried out, and the samples included are generally small.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury

Soler¹,

Prévinaire

Hadiji³

2015

Spinal Cord

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Study design: This is a retrospective study. Objectives: The objective of this study was to determine outcome predictors for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia (DSD) in patients with spinal cord injury. Methods: Botulinum toxin type A (100 Units Botox, Allergan) was injected into the external urethral sphincter using a transperineal approach under EMG guidance. Treatment was indicated if DSD was found on urodynamic testing with a post-void residual volume (PVR) above 100 ml. Urodynamic tests and cystourethrograms were performed at baseline. Dysuria (scale of 1-5) and PVR (48-h bladder diary) were evaluated at baseline and 1 month. The outcome was deemed excellent when PVR was equal to or o100 ml and 20%, and dysuria rated o3. Results: Seventy-two men with tetraplegia and 27 with paraplegia were included. There were significant reductions in PVR (from 227 to 97 ml and 63% to 27%) and dysuria (from 4.3 to 2.3). Excellent outcomes were found in 48 patients (48%), and the duration of effectiveness was 6.5 months. The need for catheterisation was decreased or eliminated in 18 patients. Vesicoureteral reflux disappeared in some patients. Poor outcome was significantly related to the presence of bladder neck dyssynergia and the absence of detrusor contraction in standard cystometry. Outcome was also related to the severity of DSD, with a strong correlation between PVR before and after injection (r = 0.58). Injections were repeated in 36 patients and yielded similar outcomes in most cases (89%). Conclusions: Detrusor contractions (odds ratio = 8.6) and normal bladder neck activity (odds ratio = 7.1) are strong predictors of excellent outcome.

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