BOTULINUM-A TOXIN AS A TREATMENT OF DETRUSOR-SPHINCTER DYSSYNERGIA - A PROSPECTIVE-STUDY IN 24 SPINAL-CORD INJURY PATIENTS

Purpose: The paralytic effect of botulinum-A toxin injections on the e xternal urethral sphincter was investigated prospectively in patients with neurogenic voiding disorders. Materials and Methods: Transurethra l versus transperineal botulinum-A toxin injections were performed in 24 spinal cord injury male patients with detrusor-sphincter dyssynergi a and the respective efficacy was compared. Results: In 21 of 24 patie nts detrusor-sphincter dyssynergia was significantly improved with a c oncomitant decrease in post-void residual volumes in most cases. Botul inum-A toxin effects lasted 3 to 9 months, making reinjections necessa ry. Conclusions: Although costly, botulinum-A toxin injections, which aim at suppressing detrusor-sphincter dyssynergia but not bladder neck dyssynergia, appear to be a valid alternative for patients who do not desire surgery or are unable to perform self-catheterization.