Transrectal Ultrasound–Guided Transperineal Botulinum Toxin A Injection to the External Urethral Sphincter for Treatment of Detrusor External Sphincter Dyssynergia in Patients With Spinal Cord Injury

Volume 91, Issue 3, Pages 340-344 (March 2010)

Abstract 

Chen S-L, Bih L-I, Chen G-D, Huang Y-H, You Y-H, Lew HL. Transrectal ultrasound–guided transperineal botulinum toxin A injection to the external urethral sphincter for treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury.

Objective

To evaluate the effects of a single transrectal ultrasound (TRUS)–guided transperineal injection of botulinum toxin A (BTX-A) to the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD).

Design

Descriptive study.

Setting

Rehabilitation hospital affiliated with a medical university.

Participants

Patients (N=18) with suprasacral spinal cord injury who had DESD confirmed on video-urodynamic study.

Interventions

A single dose of 100U BTX-A was applied into the EUS via TRUS-guided transperineal route injection.

Main Outcome Measures

Maximal detrusor pressure, detrusor leak-point pressure, integrated electromyography (iEMG), maximal pressure on static urethral pressure profilometry, and postvoiding residuals.

Results

There were significant reductions in iEMG (P=.008) and static (P=.012) and dynamic urethral pressure (P=.023), but not in detrusor pressure and detrusor leak-point pressure after treatment. Postvoiding residuals also significantly decreased in the first and second month after treatment (P<.012).

Conclusions

TRUS-guided transperineal injection of BTX-A has beneficial effects in treating DESD.

Key Words: Autonomic dysreflexia, Botulinum toxins, Rehabilitation, Ultrasonography, Urinary bladder, Urodynamics

List of Abbreviations: BTX-A, botulinum toxin A, DESD, detrusor external sphincter dyssynergia, iEMG, integrated electromyography, PVR, postvoiding residual, SCI, spinal cord injury, TRUS, transrectal ultrasound

a Department of Urology, Chung Shan Medical University, Taichung, Taiwan

b Department of Physical Medicine and Rehabilitation, Chung Shan Medical University, Taichung, Taiwan

c Department of Obstetrics and Gynecology, Chung Shan Medical University, Taichung, Taiwan

d Chung Shan Medical University Hospital, School of Medicine, Chung Shan M.edical University, Taichung, Taiwan

e Department of Nursing, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan

f Department of Physical Medicine and Rehabilitation Service, VA Boston Healthcare System, Boston, MA