Therapeutic satisfaction and dissatisfaction in patients with spinal cord lesions and detrusor sphincter dyssynergia who received detrusor botulinum toxin a injection.
OBJECTIVE
To investigate satisfaction in terms of quality-of-life (QOL) improvement among patients with spinal cord lesions and detrusor sphincter dyssynergia treated with botulinum toxin A (BoNT-A) injections to the detrusor for urinary incontinence and bladder dysfunction.


METHODS
A total of 50 patients with spinal cord lesion and detrusor sphincter dyssynergia were treated with BoNT-A injections (200 U) into the urinary bladder detrusor muscle. The urodynamic parameters, QOL scores, and general satisfaction with the treatment were assessed.


RESULTS
Overall satisfactory results were perceived by 78% of patients who received detrusor BoNT-A injections. The maximal bladder capacity had increased significantly (221 +/- 107 vs 432 +/- 115 mL, P = .000), detrusor pressure decreased (43.5 +/- 21.1 vs 12.6 +/- 10.7 cm H(2)O, P = .000), and postvoid residual urine volume increased (121 +/- 107 vs 325 +/- 123 mL, P = .000) by 3 months after BoNT-A treatment. Patients had significant improvement in QOL indexes (Urogenital Distress Inventory 6-item short form 11.7 +/- 2.3 vs 4.1 +/- 2.1, P = .01; and Incontinence Impact Questionnaire, 7-item short form 16.3 +/- 3.5 vs 11.7 +/- 4.1, P = .03) after BoNT-A treatment. Decreases in incontinence grade and urgency episodes contributed the most to satisfaction, and increased difficulty in urination and the need for catheterization contributed to dissatisfaction. Of the 50 patients, 25 (50%) received repeated BoNT-A injections; 4 patients finally decided to undergo augmentation enterocystoplasty because they desired permanent corrections and did not wish to receive repeated injections.


CONCLUSIONS
The patient satisfaction rate was 78%, and QOL improved among these patients after detrusor BoNT-A injections for urinary incontinence and bladder dysfunction.
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan. hck@tzuchi.com.tw
Hann-Chorng
HC
Kuo
D000328:Adult; D000368:Aged; D001259:Ataxia / Q000188:drug therapy / Q000209:etiology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017060:Patient Satisfaction; D011788:Quality of Life; D013118:Spinal Cord Diseases / Q000150:complications*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A