Causes of Failed Urethral Botulinum Toxin A Treatment for Emptying Failure

Liao, Yung-Ming; Kuo, Hann‐Chorng

doi:10.1016/j.urology.2007.06.1083

Cited by 37 publications

(38 citation statements)

References 16 publications

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“…Kuo 15 reported satisfactory outcomes in 11 patients with SCI, and Liao and Kuo 10 found that the therapeutic result was as good as following the first treatment in all 21 patients with neurogenic and non-neurogenic bladder. We showed that the effectiveness of repeat injections was similar to that of initial injections in most patients (89%).…”

Section: Discussionmentioning

confidence: 97%

“…2,12 The rationale for treating patients with SCI and DSD with botulinum toxin is based on the results of two placebo-controlled studies 5,6 and other open studies. 1,[4][5][6][7][8]10,[13][14][15][16] Most studies involved doses of 100 U of botulinum toxin type A (Botox, Allergan). 17 Two techniques have been described, involving endoscopic or transperineal approaches, with similar outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…These results illustrate that, even though patients can regain sustained detrusor contractility after a single injection of urethral botulinum toxin, detrusor underactivity or areflexia can persist. 1,10 The Blaivas classification is commonly used to grade DSD. It differentiates three types of DSD according to the pattern of external urethral sphincter electromyographic activity.…”

Section: Discussionmentioning

confidence: 99%

“…Sphincteric stenting is another option with a satisfactory success rate of 75% at 3 months; however, this technique is also associated with short-and long-term complications. 9 The reasons for the failure of botulinum toxin injections are not fully understood: detrusor underactivity, 1 bladder neck dyssynergia (BND), 1,7 type of DSD and the dose or dilution of the toxin 10 have been suggested to affect effectiveness. However, few studies have been carried out, and the samples included are generally small.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury

Soler¹,

Prévinaire

Hadiji³

2015

Spinal Cord

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Study design: This is a retrospective study. Objectives: The objective of this study was to determine outcome predictors for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia (DSD) in patients with spinal cord injury. Methods: Botulinum toxin type A (100 Units Botox, Allergan) was injected into the external urethral sphincter using a transperineal approach under EMG guidance. Treatment was indicated if DSD was found on urodynamic testing with a post-void residual volume (PVR) above 100 ml. Urodynamic tests and cystourethrograms were performed at baseline. Dysuria (scale of 1-5) and PVR (48-h bladder diary) were evaluated at baseline and 1 month. The outcome was deemed excellent when PVR was equal to or o100 ml and 20%, and dysuria rated o3. Results: Seventy-two men with tetraplegia and 27 with paraplegia were included. There were significant reductions in PVR (from 227 to 97 ml and 63% to 27%) and dysuria (from 4.3 to 2.3). Excellent outcomes were found in 48 patients (48%), and the duration of effectiveness was 6.5 months. The need for catheterisation was decreased or eliminated in 18 patients. Vesicoureteral reflux disappeared in some patients. Poor outcome was significantly related to the presence of bladder neck dyssynergia and the absence of detrusor contraction in standard cystometry. Outcome was also related to the severity of DSD, with a strong correlation between PVR before and after injection (r = 0.58). Injections were repeated in 36 patients and yielded similar outcomes in most cases (89%). Conclusions: Detrusor contractions (odds ratio = 8.6) and normal bladder neck activity (odds ratio = 7.1) are strong predictors of excellent outcome.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury

Soler¹,

Prévinaire

Hadiji³

2015

Spinal Cord

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“…La vidange vésicale dépend directement de la contractilité détrusorienne, le traitement ne restaure pas la synergie vésicosphinctérienne mais tend à modifier l'équilibre entre forces d'expulsion et forces de rétention, plus les premières sont élevées et plus la vidange vésicale sera efficace. L'hypocontractilité détrusorienne est d'ailleurs un facteur d'échec thérapeutique souligné par différents auteurs [10,17,21,24]. Le caractère multiloculaire de l'atteinte neurologique dans la SEP, à la fois médullaire et corticale, peut en partie expliquer cette variation de la contractilité, alors que dans les atteintes médullaires complètes, la vessie fonctionne sur un mode réflexe, l'hyperactivité étant liée à l'interruption des voies inhibitrices ainsi qu'à des modifications anatomiques locales.…”

Section: Dyssynergie Vésicosphinctérienneunclassified

Indication et résultats de la toxine botulique en injection intrasphinctérienne dans les dysuries d’origine neurologique

Gallien¹,

Duruflé²,

Nicolas³

et al. 2009

Pelv Perineol

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La toxine botulique est utilisée en thérapeutique depuis de nombreuses années avec une efficacité qui n'est plus à démontrer. Les toxines botuliques agissent au niveau présynaptique de la jonction neuromusculaire, provoquant une dénervation chimique du muscle. Dans le cadre des dysfonctionnements vésicosphinctériens, l'injection intraurétrale a pour but de diminuer la pression sphinctérienne, de favoriser ainsi la vidange vésicale et d'améliorer la dysurie. Deux techniques d'injections ont été proposées, la première par voie endoscopique et la seconde par voie périnéale après repérage électromyographique. Aucune technique n'a montré sa supériorité par rapport à l'autre. Les doses injectées varient de 50 à 100 U de Botox ® et de 150 à 250 U de Dysport ® , avec des résultats satisfaisants sur la vidange vésicale dans le cadre des dyssynergies vésicosphinctériennes sur les lésions médullaires traumatiques et les vessies hypoactives. Par contre, l'action sur le résidu est moins nette dans la sclérose en plaques. La toxine induit une diminution de la pression urétrale ainsi que de la pression intradétrusorienne. Une excellente tolérance thérapeutique est observée. La toxine botulique reste un traitement à discuter dans le cadre des troubles de la vidange vésicale d'origine neurologique. Mots clés Vessie neurologique · Dyssynergie vésicosphinctérienne · Toxine botulique · Sphincter urétralAbstract Botulinum toxin has been used for many years. It has proved to be a safe and effective therapy. The neurotoxin binds to the peripheral cholinergic terminals and inhibits acetylcholine release at that junction leading to flaccid paralysis. In cases of vesico-urethral disorders, the aim of the injection is to facilitate voiding, improve dysuria and reduce urethral pressure. Two injection techniques have been described: via cystoscopy or using transperineal injection. No study has been performed to compare the two techniques. The dose of toxin varies from 50 to 100 U for Botox ® and from 150 to 250 U for Dysport ® with good results in patients suffering from detrusor-sphincter dyssynergia after traumatic spinal cord injuries or with underactive neurogenic bladder. However, the toxin seems to be less effective for voiding in multiple sclerosis. Botulinum toxin causes a decrease in urethral pressure and also in detrusor pressure. Good tolerance is generally observed. Botulinum toxin must be considered in cases of neurological voiding disorders.

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Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity

Jiang

Chen

Jhang

2018

Neurourology and Urodynamics

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Causes of Failed Urethral Botulinum Toxin A Treatment for Emptying Failure

Cited by 37 publications

References 16 publications

Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury

Predictors of outcome for urethral injection of botulinum toxin to treat detrusor sphincter dyssynergia in men with spinal cord injury

Indication et résultats de la toxine botulique en injection intrasphinctérienne dans les dysuries d’origine neurologique

Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity

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