Effect of single botulinum toxin A injection to the external urethral sphincter for treating detrusor external sphincter dyssynergia in spinal cord injury

Chen, Sung Lang; Bih, Liu Ing; Huang, Yao Zhi; Tsai, Su Ju; Lin, Tzer Bin; Kao, Yu Lin

doi:10.2340/16501977-0255

Cited by 40 publications

(33 citation statements)

References 29 publications

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“…However, one study showed that sphincter activity became intermittent in patients with initially strong, continuous DSD, with a significant reduction in integrated EMG. 13 Our results showed that treatment outcome was related to the severity of DSD, with a strong correlation between PVR values before and after injection. Results in patients on urinary retention because of continuous DSD (type 3 in the Blaivas classification) were generally poor; only 20% had an excellent outcome (three out of 15 patients).…”

Section: Discussionmentioning

confidence: 65%

“…AD is generally improved in most patients 4,5,7,8,13 but not all. 1 Change in voiding mode has been reported in most studies, and it is of clinical importance.…”

Section: Discussionmentioning

confidence: 99%

“…18 The results for urodynamic parameters are conflicting and not necessarily correlated with clinical improvement. 17 Detrusor pressure may 7,8 or may not be improved, 1,4,5,13 detrusor leak point pressure either remains unchanged 4,13 or decreases significantly. 8 Only decreases in urethral pressure have been systematically reported.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: 65%

“…AD is generally improved in most patients 4,5,7,8,13 but not all. 1 Change in voiding mode has been reported in most studies, and it is of clinical importance.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…Takođe je dokazan povoljan efekat tretmanom intramuskularnim injekcijama botulinskog toksina A cistoskopski u spoljašnji uretralni s nkter čime se smanjuje spasticitet i dissinergija s nktera mokraćne bešike. 13,17,18 Za smanjenje ekscitabilnosti detrusora mokraćne bešike vrlo su se e kasnim pokazali antiholinergici. 19 f) Za stimulaciju glatke muskulature mokraćne bešike koriste se eksponencijalne struje.…”

Section: Terapija Neurogene Disfunkcije Mokraćne Bešikeunclassified

The treatment of neurogenic bladder dysfunction in patients with spinal cord injury

Marković¹,

Veljković²,

Zečević-Luković³

2013

PONS

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Neurogena disfunkcija mokraćne bešike nastala kao posledica oštećenja nervnih struktura kod spinalnih lezija predstavlja veliki problem za pacijenta, njegovu okolinu i zdravstvene radnike. Pravilno dijagnostikovanje neurogene disfunkcije mokraćne bešike omogućava primenu odgovarajućeg terapijskog i rehabilitacionog plana koji će omogućiti adekvatno pražnjenje i sprečavanje pojave komplikacija koje mogu ugroziti život pacijenta. U evoluciji povreda kičmene moždine mogu se razlikovati tri faze: 1) faza spinalnog šoka, 2) faza oporavka, 3) nalna faza. Posle spinalne traume m. bešika je zhvaćena najčešće na dva načina: 1) Spastična (re eksna) bešika nastaje zbog lezije iznad centra za mokrenje (segmenti S2-S4), 2) Flakcidna (atonična) neuropatska bešika nastaje kao posledica lezije u nivou centra za mokrenje (S2-S4) ili ispod njega, kao i lezije periferne inervacije bešike, 3) Sindrom autonomne disreeksije se razvija u bolesnika sa cervikalnim ili visokim torakalnim lezijama kičmene moždine, iznad 1 segmenta, 4) Neinhibirana neurogena bešika razvija se zbog inkompletnih lezija nervnih puteva u cerebralnom korteksu, piramidalnom putu ili u kičmenoj moždini oslabljena je cerebralna kontrola mokrenja. Dijagnoza neurogene disfunkcije se postavlja na osnovu urodinamskih ispitivanja, laboratorijskih pregleda urina i krvi, kao i rentgena, kompjuterizovane tomogra je i nuklearne magnetne rezonance kičmenog stuba. Pražnjenje mokraćne bešike moguće je intermitetnom kateterizacijom, Credeovim postupkom, suprapubičnom stimulacijom, elektrostimulacijom glatke muskulature mokraćne bešike i medikamentima. Neophodnost interdisciplinarnog pristupa lečenju ovih pacijenata ukazuje na svu težinu problema kod pacijenata sa povredama kičmenog stuba i posledične disfunkcije mokraćne bešike.Ključne reči: povreda kičmene moždine; neurogena disfunkcija m. bešike; rehabilitacija Neurogenic bladder dysfunction, resulted from demage to the neural structures in spinal lesion present a major problem for the patient, his environment and health care workers. Proper diagnosis of neurogenic bladder dysfunction allows you to implement appropriate treatment plan that will allow adequate emptying and prevention of complications that may endanger the patient's life .The evolution of spinal cord injuries can distinguish three phases: 1) spinal shock phase, 2) the recovery phase, 3) final phase. After spinal trauma bladder is affected mostly in two ways: 1) Spastic (reflex) bladder caused in lesion above voiding center (S2-S4 segments), 2) Flaccid (atonic) neuropathic bladder emerges in lesion at the voiding center (S2-S4) or below it, as well as lesions of the peripheral innervation of bladder, 3) Autonomic disreflection syndrome develops in patient with cervical or high thoracic spinal cord lesions, above the Th 1 segment, 4) Uninhibited neurogenic bladder develops in incomplete nerve pathway lesions in cerebral cortex, pyramidal pathway or in spinal cord -cerebral voiding control debilitate.The diagnosis of neurogenic bladder dysfunction is established ...

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Corcos

Przydacz

2017

Consultation in Neurourology

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Effect of single botulinum toxin A injection to the external urethral sphincter for treating detrusor external sphincter dyssynergia in spinal cord injury

Cited by 40 publications

References 29 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

The treatment of neurogenic bladder dysfunction in patients with spinal cord injury

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