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Urol Int. 2004;73(2):156-61; discussion 161-2.

Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions.

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1
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.

Abstract

PURPOSE:

Detrusor overactivity and urethral sphincter pseudodyssynergia may develop during recovery from cerebrovascular accidents or intracranial lesions, resulting in difficulty in urination, a large amount of residual urine, and recurrent urinary tract infection. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating these patients.

METHODS:

Twenty-one patients with chronic cerebrovascular accidents or intracranial lesions and difficult urination were enrolled. Patients participating in the study elected to receive either 100 units of botulinum A toxin (n = 11) or served as medically treated controls (n = 10). The urodynamic parameters and voiding efficiency after treatment were compared between the 2 groups.

RESULTS:

An excellent result was obtained in 6 patients and an improved result in 4 patients, resulting in an overall success rate of 91% in the study group. Four patients with frank urinary retention before treatment resumed spontaneous voiding. The maximal effects of botulinum A toxin appeared about 2 weeks after treatment. The voiding pressure decreased (57.8 +/- 35.2 vs. 33.8 +/- 16.9 cm H2O, p = 0.005) and the maximal flow rate increased (7.2 +/- 5.9 vs. 10.3 +/- 5.2 ml/s, p = 0.005) significantly. In the control group, 4 patients (40%) had spontaneous voiding 6 months after medical treatment, whereas 6 patients remained unchanged requiring an indwelling Foley catheter (n = 2) or clean intermittent catheterization (n = 4). The symptom score and the quality of life index showed significantly greater improvement in the study group than in the control group.

CONCLUSION:

This study demonstrates that urethral injection of botulinum A toxin is effective and without adverse effects in the treatment of patients with urethral sphincter pseudodyssynergia after cerebrovascular accidents or the development of intracranial lesions.

PMID:
15331901
DOI:
10.1159/000079697
[Indexed for MEDLINE]
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