Effect of single botulinum toxin A injection to the external urethral sphincter for treating detrusor external sphincter dyssynergia in spinal cord injury.
OBJECTIVE
To evaluate the effect of a single cystoscopic injection of botulinum toxin to the external urethral sphincter in treating detrusor external sphincter dyssynergia.


METHODS
An open treatment trial with pre- and post-treatment evaluations.


METHODS
A total of 20 suprasacral spinal cord injured patients with pure detrusor external sphincter dyssynergia.


METHODS
A single dose of 100 IU botulinum toxin A was applied into the external urethral sphincter via cystoscopy. Outcome measurements included maximal detrusor pressure, maximal urethral pressure, detrusor leak point pressure, integrated electromyography, and maximal pressure on static urethral pressure profilometry obtained 4 weeks post-treatment. Post-voiding residuals were checked pre- and post-injection.


RESULTS
There were significant reductions in integrated electro notmyography and static and maximal urethral pressure, but not in maximal detrusor pressure and detrusor leak point pressure after treatment. Post-voiding residuals were significantly decreased at all evaluation periods. In the sub-group analysis, patients who showed good effects of treatment had significantly lower baseline integrated electro-myography (p<0.05).


CONCLUSIONS
This study demonstrates the effect of a single cystoscopic injection of botulinum toxin in detrusor external sphincter dyssynergia. Integrated electromyography is a good evaluation tool for the net effect and dosage of botulinum toxin. Patients with severe spasticity over the external urethral sphincter may require repeated injections or higher doses.
Department of Urology, Chung Shan Medical University Hospital, Taichung City, Taiwan.
Sung-Lang
SL
Chen
Liu-Ing
LI
Bih
Yu-Hui
YH
Huang
Su-Ju
SJ
Tsai
Tzer-Bin
TB
Lin
Yu-Lin
YL
Kao
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D003558:Cystoscopy; D004576:Electromyography; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology; D014522:Urethral Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A