Treatment outcomes of detrusor underactivity in women based on clinical and videourodynamic characteristics

Chen, Sheng‐Fu; Jhang, Jia‐Fong; Jiang, Yuan‐Hong

doi:10.1007/s11255-022-03175-8

Cited by 5 publications

(2 citation statements)

References 23 publications

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“…Sufficient abdominal pressure is necessary for triggering spontaneous voiding after urethral BoNT-A injections in patients with DU. In our previous study, female DU patients exhibited VE improvement after active treatment, and intact bladder sensations and smaller PVR had better treatment outcomes [ 18 ]. In this study, we also found that a large PVR is a negative predictor, and the receiver operating characteristic curve showed that PVR > 250 mL at baseline indicates a poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Urethral Sphincter Botulinum Toxin A Injection for Non-Spinal Cord Injured Patients with Voiding Dysfunction without Anatomical Obstructions: Which Patients Benefit Most?

Chen

Kuo

2023

Toxins

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Objective: Treating voiding dysfunction without anatomical obstructions is challenging. Urethral onabotulinum toxin A (BoNT-A) is used in treating voiding dysfunction; however, the success rate varies widely, and patients may not be satisfied with the treatment outcome. This study compared the efficacy of the urethral BoNT-A injection between patients with different non-spinal cord injury (SCI) voiding dysfunctions. Materials and Methods: This study retrospectively analyzed patients with refractory voiding dysfunction, including detrusor underactivity (DU), dysfunctional voiding (DV), and poor relaxation of the external sphincter (PRES) who received the urethral sphincter 100 U BoNT-A injection. The treatment outcomes were assessed via a global response assessment (GRA) one month after treatment. Baseline and follow-up videourodynamic study (VUDS) parameters were also compared. Results: Totally, 161 patients (60 with DU, 77 with DV, and 24 with PRES) with a mean age of 58.8 ± 20.2 were enrolled, of which 62.1% had a good response (GRA ≥ 2) after urethral BoNT-A injection. DV patients had a higher success rate (76.6%) than DU (50%) and PRES (45.8%) patients (p = 0.002). A diagnosis of DV, higher voided volume and recurrent urinary tract infection were predictors of a good treatment response, while the cervical cancer status post-radical surgery predicted a poor response. Receiver operating characteristic (ROC) curve analyses identified PVR >250 mL as a negative predictor (p = 0.008) in DU patients. Conclusions: The urethral BoNT-A injection provides a satisfactory success rate for non-SCI voiding dysfunction. Patients with DV benefit most from both subjective and objective parameters. Approximately 50% of patients with DU and PRES also had a fair response. PVR > 250 mL was a negative predictor in DU patients.

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Section: Discussionmentioning

confidence: 99%

Urethral Sphincter Botulinum Toxin A Injection for Non-Spinal Cord Injured Patients with Voiding Dysfunction without Anatomical Obstructions: Which Patients Benefit Most?

Chen

Kuo

2023

Toxins

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“…After Botox injection, the Qmax increased, maximum urethral pressure decreased, and PVR decreased; however, the therapeutic effect seemed to last for only 3 months [ 145 ]. In a recently published article, female patients with DU showed improvement in voiding efficiency after urethral Botox injections, but patients with very low detrusor contractility, an absence of bladder sensation, and a tight bladder neck in a videourodynamic study showed less-favorable treatment outcomes [ 146 ].…”

Section: Potential Clinical Applications Of Botox On Recurrent Uti De...mentioning

confidence: 99%

Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do?

Kuo

2022

Toxins

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Botulinum toxin A (Botox) had been considered a promising drug that has an effect on functional disorders of the lower urinary tract. Because Botox exhibits anti-inflammatory and antispasmodic effects, Botox injection into the bladder can decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations. Injecting Botox into the bladder outlet can relax the hyperactivity of the bladder neck, and of the urethral smooth and striated muscles. Based on these therapeutic effects, Botox has been widely applied to treat lower-urinary-tract dysfunctions (LUTDs) such as overactive bladder and neurogenic detrusor overactivity. However, this treatment has not been licensed for use in other LUTDs such as interstitial cystitis, voiding dysfunction due to benign prostatic hyperplasia in men, and dysfunctional voiding in women. Botox has also not been approved for the treatment of children with overactive bladder and dysfunctional voiding; in patients with spinal cord injuries with detrusor sphincter dyssynergia and autonomic dysreflexia; or for poorly relaxed external sphincter in non-neurogenic patients. This article reviews the current knowledge regarding Botox treatment for LUTDs and discusses the potential clinical applications of Botox, as well as work that can be conducted in the future.

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Sensations in the Urinary Bladder

Wyndaele

2022

Sensation in the Pelvic Region

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Treatment outcomes of detrusor underactivity in women based on clinical and videourodynamic characteristics

Cited by 5 publications

References 23 publications

Urethral Sphincter Botulinum Toxin A Injection for Non-Spinal Cord Injured Patients with Voiding Dysfunction without Anatomical Obstructions: Which Patients Benefit Most?

Urethral Sphincter Botulinum Toxin A Injection for Non-Spinal Cord Injured Patients with Voiding Dysfunction without Anatomical Obstructions: Which Patients Benefit Most?

Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do?

Sensations in the Urinary Bladder

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