New aspects in the treatment of detrusor-sphincter dyssynergia with botulinum toxin-A

Purpose: The paralytic effect of two types of botulinum-A toxins injections Botox(R) versus Dysport(R) on the external sphincter was investigated pros pectively in neurogenic voiding disorders. Patients and methods: BTX-A injections into the external urethral sphincter (100 units Botox(R) or 250 units Dysport(R)) were performed in 10 male spi nal cord injury patients with detrusor sphincter dyssynergia (DSD). Patient s were reassessed clinically 4 to 6 weeks after treatment. In cases of pers istent difficulty in voiding or high post-void residual volume, patients we re reinjected with the same product. Patients were injected maximally 3 tim es with botulinum toxin-A per treatment cycle. Urodynamic examinations were carried out in all patients at least within 3 and 6 months following the l ast injection. If insufficient urodynamical and clinical results were found , a single reinjection of botulinum toxin was planned. If no reinjection wa s done, the patients were asked to come back for a new clinical and urodyna mical control after 3 months. Results: 30 botulinum-A injection cycles were performed in 10 patients. One cycle consists of 1 or 2 or 3 injections and corresponds to one treatment. Considering the sequency CMG(0) (Cystomanometrography, base line) - treatm ent- CMC1 (first urodynamic control), there was a significant decrease in t he duration of detrusor-sphincter dyssynergia (p < 0.05) after botulinum-A injections. There was a marked shortening of the time elapsing between the beginning of bladder contraction and voiding (p < 0.05) and a reversal of t he DSD from a type II to a type I (p < 0.05) after treatment. All patients with residual volume before injection showed a marked decrease of it after treatment. These effects lasted at least 6 months. There was a significantl y better improvement of the urodynamic parameters after Botox(R) than after Dysport(R) injections (p < 0.05). However, compared to the administered Bo tox(R) doses, the dosage of Dysport(R) was considered to be too low. Conclusion: Botulinum-A toxin injection into the external urethral sphincte r is a valuable alternative treatment for DSD in spinal cord injury patient s. From this study it appears that the quality of the results depends on th e severity of the DSD prior to treatment. The more severe the DSD, the more difficult the treatment and need for repeated injections.