The Efﬁcacy and Safety of Intrasphincteric Botulinum Toxin-A Injections in Patients with Non-Spinal Cord Injury-Related Detrusor Sphincter Dyssynergia: A Retrospective Study

Biomedicines, 2023 · DOI: 10.3390/biomedicines11113016 · Published: November 10, 2023

Simple Explanation

This study explores the use of Botulinum toxin-A (BoNT-A) injections in the external urethral sphincter for patients with detrusor sphincter dyssynergia (DSD) who do not have spinal cord injuries. The primary goal was to see if these injections could reduce bladder outlet obstruction, measured by decreased detrusor pressure, and to reduce the need for indwelling urinary catheters. The study found that BoNT-A injections are feasible for reducing bladder outlet obstruction in patients with non-SCI related DSD, leading to a decreased reliance on indwelling catheters.

Study Duration

2015 to 2021

Participants

13 male patients with non-SCI related DSD

Evidence Level

Retrospective study

Key Findings

1
There was a statistically significant reduction in maximum detrusor pressure (Pdetmax) after treatment (p = 0.006).
2
All patients who had indwelling urinary catheters before the BoNT-A injection were able to become catheter-free after treatment.
3
The detrusor overactivity leak point pressure (DOLPP) was reduced in 69% of patients after treatment, but this change was not statistically significant.

Research Summary

This retrospective study evaluated the efficacy and safety of intrasphincteric BoNT-A injections in patients with non-spinal cord injury-related detrusor sphincter dyssynergia (DSD). The primary outcome was the reduction in Pdetmax and detrusor overactivity leak point pressure (DOLPP). The secondary outcome was the reduction in the number of patients relying on indwelling urinary catheters. The study concluded that EMG-guided transperineal BoNT-A injections into the EUS appear to be a feasible and safe treatment option in patients with non-SCI DSD.

Practical Implications

Clinical Practice

BoNT-A injections can be considered as a treatment option for patients with non-SCI related DSD to reduce bladder outlet obstruction.

Patient Care

Reducing the reliance on indwelling urinary catheters can decrease the risk of catheter-associated urinary tract infections.

Further Research

Prospective, multi-institutional studies are needed to confirm the efficacy and safety of BoNT-A injections in this patient population.

Study Limitations

1
Retrospective nature of the study without systematic follow-up video-urodynamic studies (V)UDS.
2
Use of two different BoNT-A dosages within the cohort.
3
Limited number of included patients with heterogeneity with respect to the underlying neurological disorders.

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