TREATMENT OF DETRUSOR SPHINCTER DYSSYNERGIA BY TRANSPERINEAL INJECTION OF BOTULINUM TOXIN

Detrusor-sphincter dyssynergia is an involuntary contraction of the ex ternal urethral sphincter during the detrusor contraction. It causes v oiding dysfunction and can lead to urologic complications such as hydr oureteronephrosis and renal failure. Patients with spinal cord injurie s are particularly vulnerable. Botulinum toxin has been used via cysto scopy to decrease the activity of the external urethral sphincter, Thi s report describes the treatment of 5 tetraplegic patients by single t ransperineal injections of botulinum toxin for detrusor-sphincter dyss ynergia, proved by a urodynamic study with electromyography. A total o f 15 injections was given, resulting in improved bladder function in a ll patients. Urodynamic assessment after treatment showed an increase of the functional detrusor capacity and a decrease of the maximal detr usor pressure during voiding. These results confirm the consideration of botulinum toxin as a treatment for detrusor sphincter dyssynergia. A single transperineal injection is a valuable, less invasive treatmen t using a cystoscopic technique. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.