Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Trocar Catheter Transurethral Botulinum Toxin A Injection in Men With Spinal Cord Injury

• Published in: Archives of physical medicine and rehabilitation Vol. 96; no. 4; pp. 614 - 619
• Main Authors: Yang, Wei Xin, MD, Zhu, Hong Jun, MD, Chen, Wei Guo, MD, Zhang, Da Wei, MD, Su, Min, MD, Feng, Jin Fa, MD, Liu, Chuan Dao, MD, Cai, Ping, BN
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Adult; Ataxia - drug therapy; Ataxia - etiology; Botulinum toxin type A; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - therapeutic use; Humans; Male; Middle Aged; Physical Medicine and Rehabilitation; Rehabilitation; Spinal Cord Injuries - complications; Ultrasonography; Ultrasonography, Interventional; Urethral Diseases - drug therapy; Urethral Diseases - etiology; Urinary bladder; Urinary retention; Urodynamics; spinal cord injury; EUS; botulinum toxin A; Botulinum toxin type A; Urinary retention; DESD; Urodynamics; BTX-A; Urinary bladder; Ultrasonography; SCI; detrusor external sphincter dyssynergia; clean intermittent catheterization; Rehabilitation; CIC; external urethral sphincter
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2014.10.003

Abstract Objective To evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI). Design Descriptive study. Setting Hospital rehabilitation department. Participants Patients (N=15; mean age, 40.5y; range, 22–64y) with suprasacral SCI with confirmed DESD determined by urodynamic study. Interventions A single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection. Main Outcome Measures Maximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate. Results After BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure ( P <.05) and detrusor leak point pressure after treatment ( P <.05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment ( P <.05). Conclusions Transrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the EUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection.