Botulinictoxin in patients with neurogenic dysfunction of the lower urinarytracts

Abstract

Botulinic toxin (ВТ) is a new method of lowering intraurethral
pressure in symptoms of obstructive voiding in patients with neurogenic
dysfunction of the lower urinary tracts (LUT). Transperineal
introduction of 100 units of ВТ type A (botox, Allergan) was used
under electromyographic control into the external urethral sphincter
of 9 patients (6 males and 3 females) with LUT neurogenic dysfunction
aged 17 to 68 years (mean age 37.2 years). Two patients had subnormal
detrusor contractility due to myelodysplasia and diabetic
polyneuropathy, two other patients -non-incontinent striated urethral
sphincter after hemorrhagic stroke and spinal contusion, five patients
suffered from detrusor-sphincteral dyssynergia (DSD) resultant from
Schmorl's hernia, multiple sclerosis, Charcot-Marie disease and
ischemic stroke of the spinal cord. Three patients had cystostomic
drainage. The rest of the patients complained of dysuria, three patients
performed self-cathetarization, mean volume of the residual
urine was 170 ml (180-240 ml). In 10 days residual urine was not
found in 2 patients with subnormal detrusor contractility and in 4 patients
with DSD. Abdominal pressure fell from 75 to 39 cm, on the
average. In DSD patients maximal detrusor pressure fell from 59 to
29 cm, on the average. Mean maximal urinary flow rate rose from
4.3 to 9.6 ml/s. In 20 days, on the average, suprapubic fistula healed
in all the patients. In a month, therapeutic effect persisted in all the
patients. Complications, side effects were not registered. ВТ treatment
to induce adequate urine evacuation in neurological patients is
a promising approach in neurourology. Further studies should find
answers to questions about regimen of ВТ introduction, loss of sensitivity,
new indications in urology.