BOTULINUM-A TOXIN TREATMENT FOR DETRUSOR-SPHINCTER DYSSYNERGIA IN SPINAL-CORD DISEASE

We studied the efficacy of endoscopic injection of Botulinum A toxin ( 150 I.U. Dysport((R))) in the treatment of detrusor-sphincter dyssyner gia in 17 patients with spinal cord disease. One month after the injec tion, the postvoiding residual urine volume (-176 mi, P<0.001), the bl adder pressure on voiding (-19 cm water, P<0.01), and the urethral pre ssure (-24 cm water, P<0.001) were significantly decreased. The modali ty of voiding was improved in 10 patients tie micturition by suprapubi c tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic effect laste d 2 to 3 months on the average. The low doses used in this study proba bly explain in part why the treatment sometimes failed. Botulinum A to xin could become an alternative treatment for detrusor-sphincter dyssy nergia in certain patients, notably in those who are refractory to sph incterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.