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Mixed incontinence in women with spinal cord injury (SCI) can be successfully treated with concomitant intradetrusor (ID) botulinum toxin (BTX) injections and suburethral sling

Abstract

We prospectively assessed the efficacy of simultaneous ID BTX injections and transobturator (TOT) and tension free vaginal tapes (TVT) in SCI women refractory or intolerant to anticholinergics. Five SCI women with urodynamically proven mixed incontinence were treated with simultaneous suburethral sling and BTX injections. TVT or TOT followed ID injection of 1000 units of English BTX in the same sitting. Patient demographics, pre and postoperative quality of life score, clinical and videocystometrogram (VCMG) parameters were recorded. Continence was assessed at 6 weeks (voiding diary and pad test), 3 months (VCMG) and then yearly. There were no immediate or long‐term complications. TVT was performed in three (two thoracic and one lumbar SCI) and TOT in two (one thoracolumbar and one lumbar SCI). Sustained improvement was seen in all clinical parameters starting from 6 weeks till the last follow up at a mean of 13.8 months. All patients were dry with improved quality of life. Corresponding changes were seen on VCMG. (Table). Mixed incontinence in SCI women refractory or intolerant to anticholinergics can be treated with simultaneous ID BTX injections and TOT or TVT with high cure and satisfaction rates. Pt. No. MCC (ml) MDP (cm of water) Detrusor hyperreflexia USI PrePostPrePostPrePostPrePost11104203316YesNoYesNo22604503818YesNoYesNo35007009320YesNoYesNo42254127442YesNoYesNo53506254615YesNoYesNo