Clinical Original Article
Effect and safety of botulinum toxin A injection in external urethral sphincter for male patients with neurogenic detrusor underactivity
Chen Hui, Xie Keji, Jiang Chonghe, Huang Maping, Huang Tianhai, Tang Ping, Ou Rubiao, Zeng Jianwen, Deng Xiangrong, Li Qingqing, Liu Qiuling, Yang Xiaoyi
Published 2019-11-15
Cite as Chin J Urol, 2019,40(11): 849-852. DOI: 10.3760/cma.j.issn.1000-6702.2019.11.011
Abstract
ObjectiveTo assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU).
MethodsA prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Qmax), maximum detrusor pressure during voiding phases (Pdet.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded.
ResultsA total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), Pdet.max(23.95 cmH2O vs. 30.01 cmH2O, P=0.019), Qmax(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH2O vs. 79.34 cmH2O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days.
ConclusionsBTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.
Key words:
Urethral sphincter; Botulinum toxin A; Neurogenic detrusor underactivity; Effect; Safety
Contributor Information
Chen Hui
Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
Xie Keji
Department of Urology, Guangzhou First People’s Hospital, Guangzhou 510180, China
Jiang Chonghe
Department of Urology, Qingyuan City People′s Hospital, Qingyuan 511500, China
Huang Maping
Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
Huang Tianhai
Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
Tang Ping
Department of Urology, Guangzhou First People’s Hospital, Guangzhou 510180, China
Ou Rubiao
Department of Urology, Guangzhou First People’s Hospital, Guangzhou 510180, China
Zeng Jianwen
Department of Urology, Qingyuan City People′s Hospital, Qingyuan 511500, China
Deng Xiangrong
Department of Urology, Guangzhou First People’s Hospital, Guangzhou 510180, China
Li Qingqing
Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
Liu Qiuling
Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
Yang Xiaoyi
Department of Urology, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou 510440, China
