Comparative study between botulinum toxin injection and partial division of puborectalis for treating anismus.
OBJECTIVE
The objective of this study was to compare the results of partial division of puborectalis (PDPR) versus local botulinum toxin type A (BTX-A) injection in treating patients with anismus.


METHODS
This prospective randomized study included 30 male patients suffering from anismus. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and electromyography. Patients were randomized into: group I which included 15 patients who were injected with BTX-A and group II which included 15 patients who underwent bilateral PDPR. Follow-up was conducted for about 1 year. Improvement was considered when patients returned to their normal habits.


RESULTS
BTX-A injection achieved initial success in 13 patients (86.7%). However, long-term success persisted only in six patients (40%). This was in contrast to PDPR which achieved initial success in all patients (100%) with a long-term success in ten patients (66.6%). Recurrence was observed in seven patients (53.8%) and five patients (33.4%) following BTX-A injection and PDPR, respectively. Minor degrees of incontinence were confronted in two patients (13.3%) following PDPR.


CONCLUSIONS
BTX-A injection seems to be successful for temporary treatment of anismus.
Farid
Mohamed
M
Mansoura Faculty of Medicine, Mansoura, Egypt.
Youssef
Tamer
T
Mahdy
Tarek
T
Omar
Waleed
W
Moneim
Hesham Abdul
HA
El Nakeeb
Ayman
A
Youssef
Mohamed
M
D000328:Adult; D000368:Aged; D001004:Anus Diseases / Q000188:drug therapy* / Q000601:surgery*; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000627:therapeutic use*; D003248:Constipation; D003710:Demography; D006487:Hemostasis; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors
D001905:Botulinum Toxins