Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia.
OBJECTIVE
Patients with spinal cord lesions and detrusor sphincter dyssynergia (DSD) may be treated with urethral sphincter botulinum toxin A (BoNT-A) injection for difficult urination or detrusor BoNT-A injection for incontinence. Although objective data showed improvement, patients might not be satisfied with the result especially in quality of life (QOL) issue. This study investigated the therapeutic results and QOL and patients' satisfaction to these two treatments.


METHODS
Patients with spinal cord lesion and DSD were treated with urethral sphincter injection of 100 U of BoNT-A for main symptoms of difficult urination and detrusor injection of 200 U of BoNT-A for main symptom of incontinence. The urodynamic parameters, QOL scores using UDI-6 and IIIQ-7 and general satisfaction were compared between two groups.


RESULTS
The overall satisfactory result was perceived in 60.6% and 77.3% in patients who received urethral and detrusor BoNT-A injection, respectively. Urodynamic parameters showed significant improvement in both groups. Urethral injection group had improvement in IIQ-7, but not in UDI-6 scores whereas detrusor injection group had improvement in all scores. The improvement of UDI-6 and IIQ-7 was significantly greater in detrusor than urethral injection group. Increase in incontinence grade was the major cause of dissatisfaction in urethral injection group, whereas increase in difficult urination and needing catheterisation were the main dissatisfaction causes in detrusor injection group.


CONCLUSIONS
There was discrepancy between the objective urodynamic results and patient satisfaction in treatment of DSD by BoNT-A injection. Patients with DSD and treated with detrusor BoNT-A had greater QOL improvement than those treated with urethral injection.
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
H-C
HC
Kuo
D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D014521:Urethra; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy*; D016055:Urinary Retention / Q000188:drug therapy*; D014563:Urodynamics
D019274:Botulinum Toxins, Type A