Therapeutic Effects of Botulinum Toxin A, via Urethral Sphincter Injection on Voiding Dysfunction Due to Different Bladder and Urethral Sphincter Dysfunctions

Lee, Yu-Khun; Kuo, Hann‐Chorng

doi:10.3390/toxins11090487

Cited by 14 publications

(14 citation statements)

References 31 publications

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“…Great patient satisfaction was also reported to be approximately 47-52% [81]. It was concluded that the major predictive factors for a successful outcome were opening of the bladder neck and a higher baseline Qmax, but not the type of USD [81]. An increased recovery rate of detrusor contractility was further reported in idiopathic DU combined with PRES [25].…”

Section: Urethral Sphincter Bont-a Injections In Patients With Poor Rmentioning

confidence: 92%

“…However, with a stricter definition of excellent outcome, only 42% of such patients had restored spontaneous voiding or had a >25% improvement in urodynamic parameters [48]. Great patient satisfaction was also reported to be approximately 47-52% [81]. It was concluded that the major predictive factors for a successful outcome were opening of the bladder neck and a higher baseline Qmax, but not the type of USD [81].…”

Section: Urethral Sphincter Bont-a Injections In Patients With Poor Rmentioning

confidence: 99%

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The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

Kao

Huang²,

Kuo

et al. 2019

Toxins

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Neurogenic and non-neurogenic urethral sphincter dysfunction are common causes of voiding dysfunction. Injections of botulinum toxin A (BoNT-A) into the urethral sphincter have been used to treat urethral sphincter dysfunction (USD) refractory to conventional treatment. Since its first use for patients with detrusor sphincter dyssynergia in 1988, BoNT-A has been applied to various causes of USD, including dysfunctional voiding, Fowler's syndrome, and poor relaxation of the external urethral sphincter. BoNT-A is believed to decrease urethral resistance via paralysis of the striated sphincter muscle through inhibition of acetylcholine release in the neuromuscular junction. Recovery of detrusor function in patients with detrusor underactivity combined with a hyperactive sphincter also suggested the potential neuromodulation effect of sphincteric BoNT-A injection. A large proportion of patients with different causes of USD report significant improvement in voiding after sphincteric BoNT-A injections. However, patient satisfaction might not increase with an improvement in the symptoms because of concomitant side effects including exacerbated incontinence, urinary urgency, and over-expectation. Nonetheless, in terms of efficacy and safety, BoNT-A is still a reasonable option for refractory voiding function. To date, studies focusing on urethral sphincter BoNT-A injections have been limited to the heterogeneous etiologies of USD. Further well-designed studies are thus needed. Key Contribution:This article summarized the effects of sphincteric BoNT-A injections among various USDs in view of pathophysiology, urodynamic outcome, and subjective patient reports.

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Section: Urethral Sphincter Bont-a Injections In Patients With Poor Rmentioning

confidence: 92%

Section: Urethral Sphincter Bont-a Injections In Patients With Poor Rmentioning

confidence: 99%

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

Kao

Huang²,

Kuo

et al. 2019

Toxins

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“…It has served as an option for DSD that is refractory to conservative treatment [7,8]. However, data on the therapeutic effects of sphincteric BoNT-A injection among different types of EUS dysfunction are scarce [9,10]. Most of such data has included gender-mixed populations.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors

Huang²,

Jan

et al. 2021

Toxins

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External urethral sphincter (EUS) dysfunction is a common, bothersome female voiding dysfunction. This study aims to analyze the characteristics of different types of female EUS dysfunction, as well as to determine the outcome predictors of sphincteric botulinum toxin A (BoNT-A) injection. Women receiving sphincteric BoNT-A injections for refractory EUS dysfunction were retrospectively reviewed. A comparison of the baseline clinical, urodynamic parameters and the treatment responses were made for patients with different EUS dysfunctions. A total of 106 females were included. Significantly increased detrusor overactivity, detrusor contracting pressure and the bladder outlet obstruction index with decreased urge sensation were noted in patients diagnosed with dysfunctional voiding or detrusor sphincter dyssynergia comparing to those diagnosed with poor relaxation of the external urethral sphincter. The average subjective improvement rate was 67% for the injection. The therapeutic effect was not affected by the type of EUS dysfunction. The multivariate analysis revealed that bladder neck narrowing and catheterization history were predictive of negative outcomes. There is a distinct urodynamic presentation for each type of female EUS dysfunction. Sphincteric BoNT-A injection provides a good therapeutic outcome for refractory EUS dysfunction. A narrowing bladder neck and a history of catheterization suggest poor therapeutic outcomes.

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“…The complex muscular system of the pelvis has multiple functions such as micturition, defecation, sexual intercourse, and childbirth. Patients may present with storage or voiding urinary symptoms, bowel symptoms, or sexual dysfunction 3‐6 . Pelvic floor disorder should be viewed as one of the causes of CPP in women.…”

Section: Introductionmentioning

confidence: 99%

Botulinum toxin A injection in the treatment of chronic pelvic pain with hypertonic pelvic floor in women: Treatment techniques and results

Chuang

Yang

Kuo

2020

LUTS

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Chronic pelvic pain (CPP) is an extremely bothersome condition which leads to major effects in women's everyday life. In addition to visceral sources of pain, pelvic floor dysfunction including myofascial pain and spasm on the pelvic floor muscles causing hypertonicity are causes often overlooked. Injecting botulinum toxin type A (BoNT-A) into hypertonic pelvic floor muscles may aid the relaxation of pelvic floor musculature. The muscles that are injected in CPP treatment include the obturator internus, levator ani (pubococcygeus, iliococcygeus, and puborectalis), and coccygeus. Generally, injections can be performed tolerably with safety under conscious sedation combined with local anesthesia. Most practitioners perform BoNT-A injection of pelvic floor muscles using anatomical landmarks identified by manual palpation only. For the precise location of injection sites, some needle guidance techniques were proposed, including electromyography, electrical stimulation, ultrasound, fluoroscopy, and/or computed tomography. Side effects of BoNT-A injection in CPP are rare and self-limiting. Because of the reversible nature of BoNT-A, reinjection appears to be necessary. Increasing proof points out that BoNT-A is a promising treatment option for CPP in women. We conducted a review of published literature in Pubmed, using chronic pelvic pain in women, hypertonic pelvic floor, and botulinum toxin as the keywords. This article aims to summarize the treatment techniques and results of BoNT-A injection for hypertonic pelvic floor in women with chronic pelvic pain. K E Y W O R D S botulinum toxin, chronic pelvic pain, hypertonic pelvic floor, treatment technique 1 | INTRODUCTION Chronic pelvic pain (CPP) is a common disorder which affects roughly 15% of women. It is a complex and usually multifactorial condition affecting more than just the pelvis. 1 Considerable emphasis is placed on diagnostic laparoscopy because of the difficulty in the identification and treatment of endometriosis, pelvic adhesions, and postinflammatory changes. In addition to visceral pain, nearly 23% of women with CPP have myofascial pain. 2 The complex muscular system of the pelvis has multiple functions such as micturition, defecation, sexual intercourse, and childbirth. Patients may present with storage or voiding urinary symptoms, bowel symptoms, or sexual dysfunction. 3-6 Pelvic floor disorder should be viewed as one of the causes of CPP in women. Spasticity of the pelvic floor muscle is a motor disorder characterized by a rise in muscle tone. 7 High-tone pelvic floor dysfunction (HT-PFD) is often seen in women with CPP and vestibulodynia. 8 The abnormally prolonged muscle contraction may result in compression of the vessels of the muscle and lead to ischemic change. Muscle contractions with oxygen deficiency that activates muscle nociceptors are

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Therapeutic Effects of Botulinum Toxin A, via Urethral Sphincter Injection on Voiding Dysfunction Due to Different Bladder and Urethral Sphincter Dysfunctions

Cited by 14 publications

References 31 publications

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

The Therapeutic Effects and Pathophysiology of Botulinum Toxin A on Voiding Dysfunction Due to Urethral Sphincter Dysfunction

Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors

Botulinum toxin A injection in the treatment of chronic pelvic pain with hypertonic pelvic floor in women: Treatment techniques and results

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