排尿障礙治療中心版權所有 treatment of voiding dysfunction by urethral injection of...

排尿障礙治療中心版權所有

Treatment of Voiding Dysfunction by Urethral Injection of

Botulinum A toxin

Hann-Chorng KuoHann-Chorng Kuo

Department of UrologyDepartment of Urology

Buddhist Tzu Chi General HospitalBuddhist Tzu Chi General Hospital


Voiding Dysfunction

Neurogenic detrusor external sphincter Neurogenic detrusor external sphincter dyssynergiadyssynergia

Dysfunctional voiding due to spastic Dysfunctional voiding due to spastic urethral sphincterurethral sphincter

Poor relaxation of sphincter & low detrusor Poor relaxation of sphincter & low detrusor contractilitycontractility

Detrusor underactivity or Detrusor failureDetrusor underactivity or Detrusor failure Detrusor areflexiaDetrusor areflexia


Therapeutic modalities for voiding dysfunction Medication: alpha-blocker, skeletal muscle Medication: alpha-blocker, skeletal muscle

relaxants, nitric oxide donorsrelaxants, nitric oxide donors Behavioral therapy: biofeedback, electrical Behavioral therapy: biofeedback, electrical

stimulation, neuromodulationstimulation, neuromodulation Surgery: transurethral sphincterotomy, TUI-Surgery: transurethral sphincterotomy, TUI-

bladder neck, urethral stentbladder neck, urethral stent Clean intermittent catheterizationClean intermittent catheterization Indwelling Foley catheter or cystostomyIndwelling Foley catheter or cystostomy


Background of Botulinum A toxin Botulinum A toxin is an inhibitor of acetylcBotulinum A toxin is an inhibitor of acetylc

holine release at the presynaptic neuromuscholine release at the presynaptic neuromuscular junctionular junction

Inhibition of acetylcholine release results in Inhibition of acetylcholine release results in regional decreased muscle contractility at thregional decreased muscle contractility at the injection sitee injection site

This chemical devervation is a reversible prThis chemical devervation is a reversible process, axons resprout in about 3-6 monthsocess, axons resprout in about 3-6 months


Mechanism of Botulinum A Toxin in Neuromuscular Junction


Clinical usefulness of Botulinum A toxin Focal dystonia, blepharospasm (Scott et al 1Focal dystonia, blepharospasm (Scott et al 1

985)985) Dysphonia (Whurr et al 1993)Dysphonia (Whurr et al 1993) Limb spasticity ( Hesse et al 1994)Limb spasticity ( Hesse et al 1994) Dysphagia (Schneider, et al 1994)Dysphagia (Schneider, et al 1994) No severe adverse effects ever reported No severe adverse effects ever reported


Clinical application of botulinum A toxin in voiding dysfunction Botulinum A toxin 20-80 U successfully treBotulinum A toxin 20-80 U successfully tre

ated 11 SCI & DESD (Dykstra et al 1988)ated 11 SCI & DESD (Dykstra et al 1988) In 21 of 24 SCI & DESD, BTX-A toxin 100 In 21 of 24 SCI & DESD, BTX-A toxin 100

U reduced residual urine and MUCP (SchurU reduced residual urine and MUCP (Schurch et al 1996)ch et al 1996)

Transperineal injection of BTX-A in 6 SCI iTransperineal injection of BTX-A in 6 SCI improved voiding function (Schurch et al 19mproved voiding function (Schurch et al 1997)97)


Clinical application of botulinum A toxin in voiding dysfunction Relief of voiding dysfunction due to prostatitis in Relief of voiding dysfunction due to prostatitis in

4 men (Maria et al 1998)4 men (Maria et al 1998) Improved bladder capacity and decreased maximal Improved bladder capacity and decreased maximal

detrusor pressure after BTX-A in 5 SCI (Gallien et detrusor pressure after BTX-A in 5 SCI (Gallien et al 1998)al 1998)

Effective in treating DESD (12), pelvic floor spastEffective in treating DESD (12), pelvic floor spasticity (8), and acontractile detrusor (1) by BTX-A icity (8), and acontractile detrusor (1) by BTX-A 80-100 IU (Michael et al 2001)80-100 IU (Michael et al 2001)


Improved Voiding Efficiency

Increased detrusor contractility in detrusor uIncreased detrusor contractility in detrusor underactivity – nerve stimulation, increased nderactivity – nerve stimulation, increased nerve densitynerve density

Reduced urethral resistance – urethral smooReduced urethral resistance – urethral smooth muscles and striated musclesth muscles and striated muscles

Recovery of detrusor contractility in idiopatRecovery of detrusor contractility in idiopathic detrusor acontractilityhic detrusor acontractility


Patients suitable for Botulinum A toxin Treatment Patients with voiding dysfunction who were Patients with voiding dysfunction who were

refractory to medication or behavioral therapyrefractory to medication or behavioral therapy Chronic SCI & DESD with low empty efficiency Chronic SCI & DESD with low empty efficiency Cauda equina lesion and difficult urinationCauda equina lesion and difficult urination Peripheral neuropathy and difficult urinationPeripheral neuropathy and difficult urination Dysfunctional voiding Dysfunctional voiding Idiopathic detrusor underactivity Idiopathic detrusor underactivity Poor relaxation of urethral sphincterPoor relaxation of urethral sphincter


Enrolled Patients Criteria

Patient is unable to void spontaneously, indwellinPatient is unable to void spontaneously, indwelling catheter, or on CISCg catheter, or on CISC

Difficult urination with low Qmax and large residDifficult urination with low Qmax and large residual urineual urine

Moderate to severe obstructive IPSS (>10 points)Moderate to severe obstructive IPSS (>10 points) High voiding pressure (>50 cm water) & low flow High voiding pressure (>50 cm water) & low flow

rate (Qmax <10ml/s) during urodynamic studyrate (Qmax <10ml/s) during urodynamic study Poor relaxation or hyperactivity of sphincter EMG Poor relaxation or hyperactivity of sphincter EMG

activity during pressure flow studyactivity during pressure flow study


Pretreatment evaluation

Conventional treatment at least 3 monthsConventional treatment at least 3 months Cystoscopy to exclude anatomical BOOCystoscopy to exclude anatomical BOO Postvoid residual urine volumePostvoid residual urine volume Videourodynamic study: voiding pressure, aVideourodynamic study: voiding pressure, a

bdominal leak point pressure, Qmax, sphincbdominal leak point pressure, Qmax, sphincteric EMG activity, urethral patency in VCteric EMG activity, urethral patency in VCUGUG

Obstructive score in IPSSObstructive score in IPSS


Obstructive symptom scoresand Quality of life index (IPSS) Residual urine sensation or retention 0-5Residual urine sensation or retention 0-5 Intermittency 0-5Intermittency 0-5 Small caliber of urine or retention 0-5Small caliber of urine or retention 0-5 Straining to void 0-5Straining to void 0-5

Quality of life index 0-6Quality of life index 0-6 Indwelling Foley catheter or on CISCIndwelling Foley catheter or on CISC


Botulinum A toxin


Botulinum A toxin therapy

100 units (1vial) is diluted to 2ml100 units (1vial) is diluted to 2ml 50-100 units are used, 4 equivalent aliquot ar50-100 units are used, 4 equivalent aliquot ar

e injected via cystoscopy guide in men and are injected via cystoscopy guide in men and around the urethra in womenound the urethra in women

Complete cardiorespiratory monitoring in ORComplete cardiorespiratory monitoring in OR Foley catheter is indwelled for 1 dayFoley catheter is indwelled for 1 day Report adverse effect (AD, hematuria, UTI)Report adverse effect (AD, hematuria, UTI)


Evaluation of Treatment Outcome Subjectively improved in voiding efficiencySubjectively improved in voiding efficiency Increase in voided volumeIncrease in voided volume Reduction of residual urine volumeReduction of residual urine volume Decrease of voiding pressure (detrusor or Decrease of voiding pressure (detrusor or

abdominal pressure)abdominal pressure) Decrease in frequency of catheterizationDecrease in frequency of catheterization Removal of indwelled Foley catheterRemoval of indwelled Foley catheter


Botulinum A Toxin Urethral Injection in Woman

**

**

****

****


Sphincter Injection Cystoscopy


Cystoscopic Urethral Injection in Men


Identification of External Sphincter in Man


Injection of 3,6, 9, and 12 o’clock Position of Urethral Sphincter


Clinical Results after Botulinum A toxin Urethral injection 50 –100 units of botulinum A toxin injected 50 –100 units of botulinum A toxin injected

to urethral striated musclesto urethral striated muscles Effect appears 2-3 days after injectionEffect appears 2-3 days after injection Detrusor pressure or abdominal leak point pDetrusor pressure or abdominal leak point p

ressure decreased and facilitate spontaneous ressure decreased and facilitate spontaneous voidingvoiding

Minimal adverse effect was notedMinimal adverse effect was noted


Materials & Methods

A total of 103 patients received urethral BotA total of 103 patients received urethral Botox injectionox injection

48 men and 55 women48 men and 55 women Aged 16 to 94, mean 54 years oldAged 16 to 94, mean 54 years old 45 patients had urinary retention45 patients had urinary retention 48 patients received 50U, 55 patients receiv48 patients received 50U, 55 patients receiv

ed 100U ed 100U


Diseases and Enrolled Patients

Dysfunctional voiding Dysfunctional voiding 2020

Detrusor hyperreflexia & external sphincter dyssynergiaDetrusor hyperreflexia & external sphincter dyssynergia 2929

Poor relaxation of urethral sphincterPoor relaxation of urethral sphincter 1919

Cauda equina lesion and detrusor areflexiaCauda equina lesion and detrusor areflexia 88

Detrusor underactivity or detrusor failureDetrusor underactivity or detrusor failure 1313

Detrusor areflexia due to peripheral neuropathyDetrusor areflexia due to peripheral neuropathy 1414


Outcome assessment

Excellent: (1) spontaneous voiding by reflex or abExcellent: (1) spontaneous voiding by reflex or abdominal straining in urinary retention patients; (2) dominal straining in urinary retention patients; (2) improvement in voiding pressure (Pabd or Pdet), improvement in voiding pressure (Pabd or Pdet), Qmax, and residual urine by >25%Qmax, and residual urine by >25%

Improved: improvement in voiding pressure, QmaImproved: improvement in voiding pressure, Qmax, and residual urine but <25%, patient is satisfactx, and residual urine but <25%, patient is satisfactory to therapeutic effectory to therapeutic effect

Failed: subjectively no improvement, persistent urFailed: subjectively no improvement, persistent urinary retention, or persistent large residual urineinary retention, or persistent large residual urine


Therapeutic Results of Urethral Botox for Voiding Dysfunction

ExcellentExcellent ImprovedImproved FailureFailure

DV (n=20)DV (n=20) 6 (30%)6 (30%) 14 (70%)14 (70%) 00

DESD (n=29)DESD (n=29) 8 (27.6%)8 (27.6%) 15 (51.7%)15 (51.7%) 6 (20.7%)6 (20.7%)

PRES (n=19)PRES (n=19) 8 (42.1%)8 (42.1%) 7 (36.8%)7 (36.8%) 4 (21.1%)4 (21.1%)

CE (n=8)CE (n=8) 5 (62.5%)5 (62.5%) 1 (12.5%)1 (12.5%) 2 (25%)2 (25%)

DF (n=13)DF (n=13) 8 (61.5%)8 (61.5%) 4 (30.8%)4 (30.8%) 1 (7.7%)1 (7.7%)

DA (n=14)DA (n=14) 5 (35.7%)5 (35.7%) 6 (42.9%)6 (42.9%) 3 (21.4%)3 (21.4%)

Total (n=103)Total (n=103) 40 (38.8%)40 (38.8%) 47 (45.6%)47 (45.6%) 16 (15.5%)16 (15.5%)


Therapeutic Results of Urethral Botox for Voiding Dysfunction

0%

10%

20%

30%

40%

50%

60%

70%

DV DESD PRES CE DF DA

Excellent

Improved

Failure

-


Changes in Urodynamic Parameters in All Patients with Successful Results

BaselineBaseline Post-BotoxPost-Botox P valueP value

CapacityCapacity 321.5±144.5321.5±144.5 317.5±147.5317.5±147.5 0.8180.818

Voiding Voiding pressurepressure

62.8±40.462.8±40.4 42.8±31.342.8±31.3 0.0000.000**

QmaxQmax 7.1±6.47.1±6.4 10.6±6.410.6±6.4 0.0000.000**

PVRPVR 226.4±164.8226.4±164.8 88.8±111.588.8±111.5 0.0000.000**

N= 66N= 66


Urethral Botox in Treatment ofDysfunctional Voiding 20 patients with dysfunctional voiding20 patients with dysfunctional voiding 7 men and 13 women7 men and 13 women High voiding pressure & a hyperactive High voiding pressure & a hyperactive

urethral sphincter activityurethral sphincter activity 6 had excellent result, 14 had improved 6 had excellent result, 14 had improved

result, no failed caseresult, no failed case Success rate was 100%Success rate was 100%


Dysfunctional Voiding (Pseudodyssynergia) in CVA


Changes in Urodynamic Parameters in Patients with Dysfunctional Voiding



QmaxQmax 10.7±7.110.7±7.1 10.3±4.810.3±4.8 0.8030.803


46.8±25.146.8±25.1 31.1±12.031.1±12.0 0.008 0.008 **

PVRPVR 141.7±135.9141.7±135.9 57.3±63.457.3±63.4 0.026 0.026 **

N= 16N= 16


Urethral Botox in Treatment of Poor Relaxation of Sphincter 19 patients (12 men & 7 women) had a low 19 patients (12 men & 7 women) had a low

voiding pressure and intermittent sphincter voiding pressure and intermittent sphincter activity during voidingactivity during voiding

8 had excellent result, 7 had improved 8 had excellent result, 7 had improved result, 4 failed (all had psychological result, 4 failed (all had psychological disorder)disorder)

In 5 patients with retention, 3 had excellent In 5 patients with retention, 3 had excellent and 1 had improved resultand 1 had improved result


Severe dysuria in Poor Relaxation of Urethral Sphincter


Changes in Urodynamic Parameters in Patients with Poor Relaxation of Urethral Sphincter



QmaxQmax 10.9±7.910.9±7.9 16.6±8.316.6±8.3 0.1760.176


39.6±26.339.6±26.3 27.9±13.927.9±13.9 0.0910.091

PVRPVR 161.6±149.4161.6±149.4 24.3±25.124.3±25.1 0.034 0.034 **

N= 8N= 8


Urethral Botox in Treatment of DESD 29 patients with DESD, 24 men & 5 women29 patients with DESD, 24 men & 5 women 27 had spinal cord lesion, 2 had multiple 27 had spinal cord lesion, 2 had multiple

sclerosissclerosis 8 had excellent result, 15 had improved 8 had excellent result, 15 had improved

result, 6 failedresult, 6 failed 4 patients with retention had excellent result4 patients with retention had excellent result High pressure or low pressure DESD had High pressure or low pressure DESD had

similar success rate (84.6% v 75%)similar success rate (84.6% v 75%)


DESD in Multiple Sclerosis with Urinary Retention


Reduction of voiding pressure in a SCI patient with DESD


Changes in Urodynamic Parameters in Patients with DESD



QmaxQmax 6.8±5.76.8±5.7 9.2±7.79.2±7.7 0.0770.077


45.7±22.745.7±22.7 30.7±15.530.7±15.5 0.016 0.016 **

PVRPVR 160.2±124.0160.2±124.0 104.6±134.6104.6±134.6 0.2270.227

N= 18N= 18


Urethral Botox in Treatment of Cauda Equina Lesion 8 patients with cauda equina lesion8 patients with cauda equina lesion 4 men and 4 women4 men and 4 women 5 had excellent, 1 had improved result5 had excellent, 1 had improved result In 6 patients with urinary retention, 4 had eIn 6 patients with urinary retention, 4 had e

xcellent result, 1 improvedxcellent result, 1 improved Repeat urethral Botox injection was necessaRepeat urethral Botox injection was necessa

ry in 1 with hypertonic sphincterry in 1 with hypertonic sphincter


Cauda Equina Lesion with Detrusor Areflexia & Isolated Sphincter Obstruction


Reduction of abdominal pressure in patient with cauda equina lesion


Detrusor Areflexia due to Cauda Equina Lesion in MS


Changes in Urodynamic Parameters in Patients with Cauda Equina Lesion



QmaxQmax 1.3±0.51.3±0.5 7.7±7.97.7±7.9 0.0650.065


75.1±43.275.1±43.2 52.7±48.052.7±48.0 0.2070.207

PVRPVR 445.7±99.8445.7±99.8 200.0±214.1200.0±214.1 0.042 0.042 **

N=7N=7


Urethral Botox in Treatment of Detrusor Failure 13 patients with detrusor failure or underact13 patients with detrusor failure or underact

ivity, 1 man & 12 womenivity, 1 man & 12 women 8 had excellent, 4 had improved result8 had excellent, 4 had improved result All 7 patients with retention could void afteAll 7 patients with retention could void afte

r urethral Botox treatmentr urethral Botox treatment Detrusor contractions reappeared in patients Detrusor contractions reappeared in patients

with detrusor failurewith detrusor failure


Recovery of Detrusor Contractility in Detrusor Failure after Botox


Changes in Urodynamic Parameters in Patients with Detrusor Failure



QmaxQmax 7.5±6.57.5±6.5 9.8±4.89.8±4.8 0.2910.291


54.9±30.954.9±30.9 38.5±19.338.5±19.3 0.025 0.025 **

PVRPVR 242.1±180.4242.1±180.4 95.4±75.995.4±75.9 0.034 0.034 **

N= 12N= 12


Urethral Botox in Treatment of Detrusor Areflexia 14 women had detrusor areflexia after 14 women had detrusor areflexia after

previous radical hysterectomyprevious radical hysterectomy Patients voided by abdominal strainingPatients voided by abdominal straining 5 had excellent, 6 had improved result5 had excellent, 6 had improved result 2 failed cases had bladder neck obstruction2 failed cases had bladder neck obstruction Improved voiding noted after TUI-BNImproved voiding noted after TUI-BN 1 patient received 21 patient received 2ndnd injection successfully injection successfully


Detrusor Areflexia after Radical Hysterectomy,s/p Botox injection


Reduction of Abdominal Voiding Pressure in Detrusor Areflexia after Radical Hysterectomy


Changes in Urodynamic Parameters in Patients with Detrusor Areflexia



QmaxQmax 4.5±4.64.5±4.6 8.3±4.68.3±4.6 0.1120.112


118.1±65.6118.1±65.6 92.3±51.192.3±51.1 0.033 0.033 **

PVRPVR 329.3±130.4329.3±130.4 195.0±186.9195.0±186.9 0.025 0.025 **

N= 14N= 14


Reduction of MUCP in a women with peripheral neuropathy


The Urethral Pressure Profile Parameters at Baseline and after Botulinum Toxin Injection

BaselineBaseline Post-BotoxPost-Botox Statistics*Statistics*

MUCP (cm water)MUCP (cm water) 97.1±31.797.1±31.7 51±23.2 51±23.2 0.027 0.027 **

FPL (cm)FPL (cm) 3.35±0.593.35±0.59 3.30±0.333.30±0.33 0.7730.773

MUCP=maximal urethral closure pressure, FPL=functional profile length,


Factors for an Effective Urethral Botox Injection Adequate dose of Botulinum A ToxinAdequate dose of Botulinum A Toxin Exact injection into urethral sphincterExact injection into urethral sphincter Hyperactive urethral sphincter is less Hyperactive urethral sphincter is less

favorable than non-relaxing sphincterfavorable than non-relaxing sphincter Psychological inhibition of sphincter Psychological inhibition of sphincter

relaxation is less favorable than organic relaxation is less favorable than organic non-relaxing sphincternon-relaxing sphincter


Relationship of Therapeutic Results and Botox Dose


50 Unit (n=48)50 Unit (n=48) 1919 2222 77

100 Unit (n=55)100 Unit (n=55) 2121 2525 99

Total (n=103)Total (n=103) 4040 4747 1616


Relationship of Therapeutic Results and Botox Dose

19

2122

25

79

0

5

10

15

20

25

Excellent Improved Failure

50 Unit

100 Unit


Relationship of Therapeutic Results and Voiding Pressure


High pressure High pressure voiding (n=33)voiding (n=33)

10 (30.3%)10 (30.3%) 21 (63.6%)21 (63.6%) 2 (6%)2 (6%)

Low pressure Low pressure voiding (n=70)voiding (n=70)

30 (42.9%)30 (42.9%) 26 (37.1%)26 (37.1%) 14 (20%)14 (20%)

Chi-square test, p= 0.063Chi-square test, p= 0.063


Relationship of Therapeutic Results and Voiding Pressure

1921

2225

7

9

0

5

10

15

20

25


High pressurevoiding

Low p r e s s u r evoid n g


Changes in Urodynamic Parameters in Patients with High Voiding Pressure



QmaxQmax 9.7±6.79.7±6.7 10.1±6.110.1±6.1 0.7450.745


52.1±23.352.1±23.3 33.3±14.133.3±14.1 0.0000.000**

PVRPVR 141.9±133.2141.9±133.2 92.5±128.192.5±128.1 0.2030.203

N= 24N= 24


Changes in Urodynamic Parameters in Patients with Low Voiding Pressure



QmaxQmax 5.8±6.15.8±6.1 10.0±6.910.0±6.9 0.000 0.000 **


69.2±53.869.2±53.8 50.5±41.750.5±41.7 0.0000.000**

PVRPVR 271.5±166.9271.5±166.9 116.8±141.7116.8±141.7 0.0000.000**

N= 50N= 50


Relationship of Therapeutic Results and Sphincter Activity


Sphincter Sphincter Hyperactivity Hyperactivity (n=68)(n=68)

22 (32.4%)22 (32.4%) 36 (52.9%)36 (52.9%) 10 (14.7%)10 (14.7%)

Sphincter HypoaSphincter Hypoactivity (n=35)ctivity (n=35)

18 (51.4%)18 (51.4%) 11 (31.4%)11 (31.4%) 6 (17.1%)6 (17.1%)

Chi-square test, p= 0.103Chi-square test, p= 0.103


Relationship of Therapeutic Results and Sphincter Activity

32.4%

51.4% 52.9%

31.4%

14.7%

17.1%

0%

10%

20%

30%

40%

50%

60%


SphincterHyper a c t i v i t y

SphincterHypo a c t i v i t y


Changes in Urodynamic Parameters in Patients with Sphincter Hyperactivity



QmaxQmax 9.0±6.79.0±6.7 11.1±7.311.1±7.3 0.0700.070


44.4±23.944.4±23.9 29.9±13.729.9±13.7 0.0000.000**

PVRPVR 154.6±128.4154.6±128.4 71.8±101.071.8±101.0 0.0020.002**

N= 43N= 43


Changes in Urodynamic Parameters in Patients with Sphincter Hypoactivity



QmaxQmax 4.5±5.34.5±5.3 8.7±5.48.7±5.4 0.0040.004**


88.8±56.488.8±56.4 64.4±45.764.4±45.7 0.0000.000**

PVRPVR 329.9±162.2329.9±162.2 158.2±162.7158.2±162.7 0.0000.000**

N=31N=31


Relationship of Therapeutic Results with Age and Sex


Male (n=48)Male (n=48) 1414 2424 1010

Female (n=55)Female (n=55) 2626 2222 77

P=0.153P=0.153

Age < 50 years (n=39)Age < 50 years (n=39) 1010 1818 1111

Age Age >> 50 years (n=64) 50 years (n=64) 3030 2828 66

P=0.018 P=0.018 **


Relationship of Therapeutic Results with Age and Sex

0

5

10

15

20

25

30

Male Female Age < 50years

Age >50years

Excellent

Improved

Failure


Presumptive Causes for Patients Failed Urethral Botox Treatment NOCENOCE SexSex AgeAge DiseaseDisease DoseDose ReasonReason

11 MM 6262 PRESPRES 100100 PsychogenicPsychogenic

22 FF 3131 PRESPRES 100100 PsychogenicPsychogenic



55 MM 3131 DESDDESD 100100 Low detrusor contractilityLow detrusor contractility


77 MM 3939 DESDDESD 5050 Sphincter Hyperactivity Sphincter Hyperactivity

88 MM 3333 DESDDESD 100100 Bladder outlet obstructionBladder outlet obstruction**

99 MM 2626 DESDDESD 100100 Sphincter Hyperactivity Sphincter Hyperactivity


1111 FF 1414 CECE 5050 Low detrusor contractilityLow detrusor contractility

1212 MM 3636 CECE 100100 Sphincter Hyperactivity Sphincter Hyperactivity

1313 FF 8080 DFDF 5050 Low detrusor contractilityLow detrusor contractility

1414 FF 6464 DADA 5050 Bladder neck obstructionBladder neck obstruction**

1515 FF 4848 DADA 100100 Bladder neck obstructionBladder neck obstruction

1616 FF 4848 DADA 100100 Sphincter Hypertonicity Sphincter Hypertonicity

* Voiding is smooth after transurethral incision of bladder neck


Bladder Neck Dysfunction Resulting in Failure Botox Treatment in Detrusor Areflexia


Reduction of MUCP after Urethral Botox in Detrusor Areflexia due to Hysterectomy


DESD and Bladder neck dysfunction after TUI-BN


Return of Detrusor Contractility after Botulinum A toxin injection In 7 patients, return of detrusor contractility In 7 patients, return of detrusor contractility

was noted at 1- 2 months after botulinum A was noted at 1- 2 months after botulinum A toxin injectiontoxin injection

Frequency, urgency or urge incontinence deFrequency, urgency or urge incontinence developed in 6 patients with detrusor underactveloped in 6 patients with detrusor underactivityivity

Rhythmic detrusor contractions developed iRhythmic detrusor contractions developed in one SCI patients with DESD and dysurian one SCI patients with DESD and dysuria


Recovery of detrusor contractility in detrusor underactivity


Rhythmic detrusor contractions in SCI with DESD after Botox


Adverse Effects of Botulinum A Toxin No urinary tract infection developedNo urinary tract infection developed One 15 y/o girl had high fever lasting for 2 One 15 y/o girl had high fever lasting for 2

weeks after injection (failed case with weeks after injection (failed case with reduced MUCP & leak pressure)reduced MUCP & leak pressure)

Six women had mild incontinence during Six women had mild incontinence during sleep (2 DV, 4 DA)sleep (2 DV, 4 DA)


Conclusions

Botulinum A toxin in 50-100 units is effective in rBotulinum A toxin in 50-100 units is effective in reducing urethral resistance and facilitate voiding eeducing urethral resistance and facilitate voiding efficiency in 84.5% of patients with voiding dysfunfficiency in 84.5% of patients with voiding dysfunction and 82.9% of detrusor underactivity ction and 82.9% of detrusor underactivity

Patients with chronic retention may have a chance Patients with chronic retention may have a chance to urinate by abdominal straining after botulinum to urinate by abdominal straining after botulinum A toxin injectionA toxin injection

Good quality of life without catheter was achieved Good quality of life without catheter was achieved after botulinum A toxin therapyafter botulinum A toxin therapy


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排尿障礙治療中心 版權所有 treatment of voiding dysfunction by urethral injection of...

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