[Botulinum A toxin in the treatment of patients with detrusor external sphincter dyssynergia and neurogenic low detrusor contractility].

Aim: To investigate safety and efficacy of botulinum A toxin external urethral sphincter injection in the treatment of patients with detrusor external sphincter dyssynergia (DSD) and neurogenic low detrusor contractility (DC).

Material And Methods: The study included 21 patients with DSD and 27 patients with low DC between 17 and 73 years of age. The diagnostic scheme consisted of voiding diary for 72 hours, laboratory tests, ultrasound investigation with measurement of residual urine volume, urodynamic investigation and neurologic examination. 100 units of botulinum A toxin (botox, allergan) were injected into external urethral sphincter paraurethrally in women and transurethrally in men.

Results: 6 months after the toxin injection good results were achieved in 6 out of 9 DSD patients with spontaneous micturition; physiologic micturition was restored in 5 out of 8 patients who had performed intermittent self catheterization and in 3 out of 4 patients with suprapubic fistula and urethral catheter. As for patients with neurogenic low DC, good results were achieved in 6 of 8 patients who had had spontaneous micturition; physiologic micturition was restored in 13 out of 14 patients who had performed intermittent self catheterization and in 3 out of 5 patients with suprapubic fistula and urethral catheter. There were neither complications nor side effects.

Conclusion: Botulinum A toxin external urethral sphincter injection demonstrated high efficacy in patients with DSD and neurogenic low DC.