Abstract
BackgroundThe aim of this retrospective study was to evaluate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection into the urethral sphincter to treat patients with underactive bladder (UAB).MethodsFrom September 2012 to December 2018, 35 patients with UAB who presented with dysuria were treated with BTX-A (Prosigne®, Lanzhou Biological Products, Lanzhou, China). All patients were evaluated using the International Continence Society standard for video-urodynamic examination before and 1 month after treatment. The index includes maximum urinary flow rate, detrusor leak point pressure, and maximum urethral pressure. Post-voiding residual urine volume was measured using ultrasound before, one and 3 months post injection.ResultsAfter 1 month of treatment, the maximum flow rate increased from 2.5 ± 1.1 ml/s to 6.6 ± 1.7 ml/s (P < 0. 05). The maximum urethral pressure decreased from 73.5 ± 5.8 cmH2o to 45.6 ± 4.3cmH2O (P < 0. 05). The detrusor leak point pressure decreased from 69.9 ± 20.7cmH2O to 26.3 ± 7.4cmH2O (P < 0. 01). Post-voiding residual urine decreased from 282.8 ± 134.2 ml to 125.0 ± 92.1 ml (P < 0. 01) but increased to 270.1 ± 129.0 ml 3 months post injection. Of the 35 patients, 57.1% (20/35) relied on clean intermittent catheterization (CIC) before injection, but 75.0% (15/20) of them could partly void 1 month after injection, and 25%(5/20) could void without CIC. Eight patients showed hydronephrosis before treatment; in three of them, hydronephrosis decreased slightly, while it resolved in two. All patients were followed for three to 6 months, and the effect lasted for about two to 3 months. No serious adverse events occurred in any patient.ConclusionsThe results suggest that Prosigne® injection into the urethral sphincter is an effective, safe, and inexpensive way to treat UAB.
Highlights
The aim of this retrospective study was to evaluate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection into the urethral sphincter to treat patients with underactive bladder (UAB)
The detrusor leak point pressure decreased from 69.9 ± 20.7cmH2O to 26.3 ± 7.4cmH2O
The results suggest that Prosigne® injection into the urethral sphincter is an effective, safe, and inexpensive way to treat UAB
Summary
The aim of this retrospective study was to evaluate the clinical efficacy and safety of botulinum toxin type A (BTX-A) injection into the urethral sphincter to treat patients with underactive bladder (UAB). Botulinum toxins (BTX) which derive from the Grampositive coccus Clostridium botulinum are the most potent known naturally occurring neurotoxins [1]. They can paralyze striated muscle by blocking acetylcholine release at the presynapse. BTX-A injection has been widely used in the treatment and research of lower urinary tract dysfunction [5]. The site of BTX-A injection is classified into simple detrusor injection for detrusor overactivity, simple sphincter injection, or detrusor-sphincter combined injection for sphincter spasm or detrusor sphincter dysfunction. Our department is the first in China to use BTX-A injection to treat lower urinary tract dysfunction.
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