Effectiveness of urethral injection of botulinum A toxin in the treatment of voiding dysfunction after radical hysterectomy.
OBJECTIVE
After radical hysterectomy for cervical cancer patients may have difficulty in urination due to detrusor underactivity and a non-relaxing urethral sphincter. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating voiding dysfunction in these patients.


METHODS
Thirty patients with difficult urination after radical hysterectomy due to cervical cancer were enrolled to receive urethral injection of 100 units of botulinum A toxin (n=20) or medical treatment as controls (n=10). The clinical results and urodynamic parameters at baseline and after treatment were compared in the study group, and the quality of life (QOL) index was compared between the study and control groups.


RESULTS
After urethral injection of botulinum A toxin, 8 patients had excellent results (40%) and 8 had improved results (40%) in the study group. Both voiding pressure (115.2+/-63.7 vs. 90.2+/-49.5 ml, p=0.025) and post-void residual volume (330.9+/-124.9 vs. 183.9+/-183.4 ml, p=0.011) improved significantly after treatment. The obstructive symptom score was significantly reduced (17.5+/-4.7 vs. 5.7+/-2.3 points, p=0.000) and the QOL index also improved (4.5+/-2.7 vs. 2.3+/-2.3 points, p=0.000) after treatment. The success rate was 80% in the study group. There were no significant changes in obstructive symptom scores or the QOL index in the control group. The maximal effect appeared about 1 week after treatment. The duration of the therapeutic effect ranged from 3 to 9 months. Mild stress urinary incontinence and nocturnal enuresis were noted in 7 patients (35%).


CONCLUSIONS
Urethral injection of botulinum A toxin can be effectively used to treat patients with detrusor underactivity and non-relaxing urethral sphincter after radical hysterectomy with few adverse effects.
Kuo
Hann-Chorng
HC
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan. hck@tzuchi.com.tw
D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007267:Injections; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D014521:Urethra; D016055:Urinary Retention / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects; D002583:Uterine Cervical Neoplasms / Q000601:surgery; D014741:Video Recording
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A