王脩仁、李宇坤、郭漢崇

花蓮慈濟醫院 泌尿部

Hsiu-Jen Wang, Yu-Khun Lee, Hann-Chrong Kuo

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan  

 

Purpose: To analyze treatment outcomes and identify predictive factors for urethral botulinum toxin A (BoNT-A) treatment of voiding dysfunction.

Materials and Methods: Patients with voiding dysfunction refractory to medical treatment were treated with injections totaling 100 U of BoNT-A into the urethral sphincter. Treatment outcomes were assessed at 1 month by Global Response Assessment and was analyzed by demographic and video-urodynamic study (VUDS).

Results: Eighty patients with non-neurogenic and 75 with neurogenic bladder dysfunction were included. Good outcomes were reported in 92 (59.4%) patients. Table 1 reveals treatment outcome was not related to gender, voiding dysfunction subtype, bladder function, or sphincter function. VUDS revealed baseline Qmax and an open bladder neck (BN) during voiding showed significant difference between groups (Table 2). An open BN was noted in 89 (96.7%) in 92 patients with successful outcome and tight BN in 54 (85.7%) who failed treatment (p<0.001). Patients with a successful outcome had significantly higher Qmax than those with failed outcome (p = 0.031). In patients with NNVD and non-DU, patients with successful outcomes had significantly higher Pdet than those with failed outcomes (p = 0.013). In patients without detrusor underactivity and non-neurogenic voiding dysfunction, those with good outcomes had significantly higher Pdet (p = 0.006). Significantly more patients with a successful outcome had an open BN during VUDS than those with a failed outcome. (Table 3)

Conclusions: BoNT-A urethral sphincter injection is effective in about 60% of patients with neurogenic or non-neurogenic voiding dysfunction.

 

 

Table 1. Treatment outcome according to patient characteristics at baseline

VD, voiding dysfunction; DO, detrusor overactivity; DU, detrusor underactivity; DHIC, detrusor hyperreflexia and inadequate contractility; HSB, hypersensitive bladder; DV, dysfunctional voiding; DSD, detrusor sphincter dyssynergia; ES, external sphincter.

 

 

Table 2. The video-urodynamic characteristics between patients with good and poor treatment outcomes

DO, detrusor overactivity; DU, detrusor underactivity; BN, bladder neck.

 

 

Table 3. Comparison of the baseline video-urodynamic parameters between patients with successful and failed treatment outcomes in different bladder and urethral sphincter dysfunctions

 

 

FSF: first sensation of filling, FS: full sensation, CBC: cystometric bladder capacity, Pdet: detrusor pressure, Pabd: abdominal pressure, Qmax: maximum, flow rate, PVR: postvoid residual, BN: bladder neck DO: detrusor overactivity, NVD: neurogenic voiding dysfunction, NNVD: non-neurogenic voiding dysfunction, DU: detrusor underactivity, DV, dysfunctional voiding; DSD, detrusor sphincter dyssynergia; NR: non-relaxing external sphincter, S: successful outcome, F: failed outcome