Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity

Jiang, Yuan‐Hong; Chen, Sheng‐Fu; Jhang, Jia‐Fong

doi:10.1002/nau.23714

Cited by 20 publications

(24 citation statements)

References 26 publications

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“…The indications include detrusor underactivity, neurogenic detrusor sphincter dyssynergia, and non-neurogenic DV. Although most studies demonstrated the efficacy of this treatment in voiding dysfunction caused by urethral sphincter hyperactivity of different etiologies, the subjective improvement rate after BoNT-A urethral sphincter injection was only 60% [ 13 , 14 , 19 ]. In the experience of the authors for the present study, patients who have an open BN on voiding cystourethrography have predictably successful therapeutic results [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women

Jiang

Lee

Chen

et al. 2021

Toxins

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Although female dysfunctional voiding (DV) is common in urological practice, it is difficult to treat. This study evaluated the therapeutic efficacy of urethral botulinum toxin A (BoNT-A) on non-neurogenic female DV. Based on the videourodynamic study (VUDS), the DV was classified into three subgroups according to the obstructive site. A successful treatment outcome was defined as an improvement of voiding efficiency by 10% and reported global response assessment by ≥1. The study compared therapeutic efficacy, baseline urodynamic parameters, and changes in urodynamic parameters between the treatment success and failure groups and among three DV subgroups. Predictive factors for successful treatment were also investigated. A total of 81 women with DV were categorized into three groups: 55 (67.9%) had mid-urethral DV, 19 (23.5%) had distal urethral DV, and 7 (8.6%) had combined BN dysfunction and mid-urethral DV after BN transurethral incision. The treatment outcome was successful for 55 (67.9%) patients and failed for 26 (32.1%). Successfully treated patients had a significant decrease of detrusor pressure, post-void residual volume, and bladder outlet obstruction index, as well as an increase in voiding efficiency at follow-up versus the treatment failure group. The logistic regression of urodynamic parameters and clinical variables revealed that a greater volume of first sensation of filling predicts a successful BoNT-A treatment outcome (p = 0.047). The urethral BoNT-A injection is effective in treating non-neurogenic women with DV, with a success rate of 67.9%. The videourodynamic characteristics of DV may differ among patients but does not affect the treatment outcome.

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Section: Discussionmentioning

confidence: 99%

“…Since no definitive medical treatment is currently available for DV, clinicians have enthusiastically used urethral botulinum toxin A (BoNT-A) for this off-label indication [ 13 ]. However, a satisfactory treatment outcome with BoNT-A has not been achievable for all patients with DV [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women

Jiang

Lee

Chen

et al. 2021

Toxins

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“…Post-treatment, improvements were noticed in several clinical aspects in those studies, such as maximal flow rate, voided urine amount, decreased detrusor voiding pressure, international prostate symptom score (IPSS), and quality of life index. However, only the total IPSS and voided volume improvements were significantly greater than those in the placebo group in a randomized controlled double-blind study [62].…”

Section: Bont-a Injection For Dysfunctional Voiding (Dv) or Bladder Nmentioning

confidence: 86%

“…Patients with non-neurogenic voiding dysfunction classically present with open bladder neck but poorly relaxed urethral sphincter and normal-to-high voiding pressure during micturition by urodynamic study and are mostly refractory to medical treatment [59]. Several recent clinical studies have shown BoNT-A injection to the external urethral sphincter could be a safe and efficient treatment method for refractory DV patients [60][61][62]. Post-treatment, improvements were noticed in several clinical aspects in those studies, such as maximal flow rate, voided urine amount, decreased detrusor voiding pressure, international prostate symptom score (IPSS), and quality of life index.…”

Section: Bont-a Injection For Dysfunctional Voiding (Dv) or Bladder Nmentioning

confidence: 99%

“…IC/BPS is a clinical syndrome described as having "An unpleasant sensation (pain, pressure, discomfort) perceived to be related to urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes" [62]. Though the real pathophysiology of IC/BPS has remained unclear for decades, recent studies have progressed in molecular biology, which have focused on urothelial dysfunction and neurogenic inflammation and could explain some part of the disease [61][62][63][64][65][66]. Urothelial defect with surface glycosaminoglycan and associated dysregulation of urothelial permeability has been established as one of the pathogenesis of IC/BPS [65].…”

Section: Bont-a Injection For Ic/bpsmentioning

confidence: 99%

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Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders

Lin

Chiang

Cui

2020

Toxins

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Intravesical botulinum toxin (BoNT) injection is effective in reducing urgency and urinary incontinence. It temporarily inhibits the detrusor muscle contraction by blocking the release of acetylcholine (Ach) from the preganglionic and postganglionic nerves in the efferent nerves. BoNT-A also blocks ATP release from purinergic efferent nerves in the detrusor muscle. In afferent nerves, BoNT-A injection markedly reduces the urothelial ATP release and increases nitric oxide (NO) release from the urothelium. BoNT-A injection in the urethra or bladder has been developed in the past few decades as the treatment method for detrusor sphincter dyssyndergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders, including bladder hypersensitivity, overactive bladder, and interstitial cystitis/chronic pelvic pain syndrome. Although the FDA only approved BoNT-A injection treatment for neurogenic detrusor overactivity and for refractory overactive bladder, emerging clinical trials have demonstrated the benefits of BoNT-A treatment in functional urological disorders. Cautious selection of patients and urodynamic evaluation for confirmation of diagnosis are crucial to maximize the successful outcomes of BoNT-A treatment.

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Botulinum toxin A injection to the external urethral sphincter for voiding dysfunction in females: A tertiary center experience

Nadeem

Lindsay

Pakzad

et al. 2022

Neurourology and Urodynamics

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The aim of this study is to examine the functional outcomes of onabotulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD). METHOD: A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX-A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI-I) scale at 6 weeks and then at 3 monthly intervals.Result: We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18-72 years) with a mean follow-up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent selfcatheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX-A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVR decreased from 200 to 149 mls (p < 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actual MUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5-point PGI-I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of

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Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity

Abstract: Subjective improvement was reported in 61.1% of patients with voiding dysfunction due to urethral sphincter hyperactivity after onabotulinumtoxinA urethral sphincter injection. An open bladder neck during voiding at baseline predicts a successful outcome.

Cited by 20 publications

References 26 publications

Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women

Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women

Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders

Botulinum toxin A injection to the external urethral sphincter for voiding dysfunction in females: A tertiary center experience

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