A Clinical Study on Botulinum A Toxin in Treatment of the Spinal Cord Injury with Neurogenic Bladder

Ao Lijuan, Li Yongmei, Qian Jinhua, Wang Wenli, Tang Mei, Zhang Lifen, Zuo Yigang, Tang Xun, Yang Yang

To evaluate the eff ects of Botulinum Toxin Type A (BTXA) injected into the external urethral sphincter in patients with dctrusorexternal sphincter dyssynergia caused by spinal cord injury. Th e eff ects of transurethral (TU) versus transperineal (TP) BTXA injection were compared. 17 male patients with detrusor-sphincter dyssynergia were divided into 2 groups: TU group and TP group. Four points injection method was employed with allocation by cystoscope in TU group. 1 point injection method percutaneous around the urethral was employed with allocation by digital rectal examination. 100U of BTXA was injected into the external urethral sphincter in each patient. Aft er BTXA injection, the voiding dysfunction was signifi cantly improved in both groups. Th ree days to 2 weeks aft er injection, times of incontinence and intermittent catheterization, post-void residual urine volume started to decrease, the volume for intermittent catheterization started to increase. One month aft er BTXA injection, the times of incontinence obviously decreased from 4.86 to 2.64. Times of intermittent catheterization decreased from 4.28 to 2,26, post-void residual urine volume obviously decreased from 220,46ml to 89.13ml. Intermittent catheterization volume increased from 109,2ml to 272.25ml. Urodynamic examination suggested the mean FDV, maximal bladder capacity statistically increased, the maximal detrusor pressure statistically decreased. Th ree months aft er BTXA injection, the parameters mentioned above rebounded without reach the level before BTXA injection. BTXA injected into the external urethral sphincter was a promising therapy for neurogenic bladder with Detrusor-sphincter Dyssynergia (DSD). Th ere was no obvious diff erence between transurethral and transperineal BTXA injection in the therapeutic eff ects.