Tzu Chi Medical Journal
Volume 19, Issue 3 , Pages 134-138, September 2007

Comparison of the Therapeutic Effects of Urethral Injections of 50 and 100 Units of Botulinum A Toxin for Voiding Dysfunction

  • Hann-Chorng Kuo

      Affiliations

    • Corresponding Author InformationCorresponding author. Department of Urology, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung Yang Road, Hualien, Taiwan

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan

Received 21 November 2006; received in revised form 8 December 2006; accepted 15 December 2006.

Article Outline

Abstract 

Objectives

Urethral injection of botulinum A toxin (BoNT-A) has therapeutic effects on voiding dysfunction. However, the optimal dose remains to be determined. This study compared the therapeutic results of urethral injections of 50 U and 100 U of BoNT-A.

Materials and Methods

Sixty-six patients with voiding dysfunction were randomly treated with urethral injections of 50 U (n = 33) or 100 U (n = 33) of BoNT-A (BOTOX). The therapeutic results and changes in the urody-namic parameters were compared between these two groups of patients.

Results

The overall therapeutic results in the 100 U and 50 U injection groups were excellent in 20 (60.6%) and 23 (69.7%) patients, improved in 10 (30.3%) and 5 (15.2%), and failed in 3 (9%) and 5 (15.2%), respectively. Significant reductions in the voiding pressure, postvoid residual volume, and maximal urethral closure pressure as well as improvement in the quality of life index and increases in the maximum flow rate were noted after treatment in both groups. No significant between-group differences were noted in the net changes of the urodynamic parameters after treatment. Excellent results were noted in 68% and 33% of patients with detrusor underactivity, and in 71.4% and 70.8% of patients with hyperactive urethral sphincter who received injections of 50 U and 100 U, respectively. The mean durations of therapeutic effect were 6.4 ± 3.6 months and 8.4 ± 3.4 months in the 50 U and 100 U groups, respectively (p = 0.022).

Conclusion

Urethral injection of 50 U of BOTOX is as effective as 100 U in the treatment of voiding dysfunction of any etiology, but the duration of therapeutic effect was significantly shorter in the group who received 50 U.

Keywords:  Botulinum A toxin , Urethral sphincter , Voiding dysfunction

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Dykstra DD , Sidi AA , Scott AB , Pagel JM , Goldish GD . Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients . J Urol . 1988;139:919–922
  2. Schurch B , Hauri D , Rodic B , Curt A , Meyer M , Rossier AB . Botulinum A toxin as a treatment of detrusor sphincter dyssynergia: a prospective study in 24 spinal cord injury patients . J Urol . 1996;155:1023–1029
  3. Kuo HC . Botulinum A toxin urethral injection for the treatment of lower urinary tract dysfunction . J Urol . 2003;170:1908–1912
  4. Phelan MW , Franks M , Somogyi GT , et al.   Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction . J Urol . 2001;165:1107–1110
  5. Chen YH , Kuo HC . Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions . Urol Int . 2004;73:156–162
  6. Schurch B , Hodler J , Rodic B . Botulinum A toxin as a treatment of detrusor-sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections . J Neurol Neurosurg Psychiatry . 1997;63:474–476
  7. Kuo HC . Effect of botulinum A toxin in the treatment of voiding dysfunction due to detrusor underactivity . Urology . 2003;61:550–554
  8. Lindsey I , Cunningham C , Jones OM , et al.   Fissurectomybotulinum toxin: a novel sphincter-sparing procedure for medically resistant chronic anal fissure . Dis Colon Rectum . 2004;47:1947–1952
  9. Trzcinski R , Dziki A , Tchorzewski M . Injections of botulinum A toxin for the treatment of anal fissures . Eur J Surg . 2002;168:720–723
  10. Autti-Ramo I , Larsen A , Taimo A , von Wendt L . Management of the upper limb with botulinum toxin type A in children with spastic cerebral palsy and acquired brain injury: clinical implications . Eur J Neurol . 2001;8(Suppl 5):136–144
  11. Abrams P , Cardozo L , Fall M , et al.   The standardization of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society . Neurourol Urodyn . 2002;21:167–181
  12. Cockett A , Aso Y , Denia Y , et al.   Recommendations of the International Consensus Committee concerning: 1. Prostate symptom score and quality of life assessment . In: Proceedings of the 2nd International Consultation on Benign Prostatic Hyperplasia (BPH), Paris, June 27–30, 1993 . Jersey, Channel Island: Scientific Communication International Ltd; 1994;p. 553

PII: S1016-3190(10)60005-5

doi:10.1016/S1016-3190(10)60005-5

Tzu Chi Medical Journal
Volume 19, Issue 3 , Pages 134-138, September 2007

Article Tools