Re: Goel S et al. Use of Botulinum Toxin A (BoNT-A) in Detrusor External Sphincter Dyssynergia (DESD): A Systematic Review and Meta-analysis. Urology. 2020. doi:10.1016/j.urology.2020.03.007

Abstract

Goel et al present an important systematic review of Botulinum toxin A in patients with detrusor external sphincter dyssynergia. 1 Goel S Pierce H Pain K Christos P Dmochowski R Chughtai B Use of botulinum toxin a (BoNT-A) in detrusor external sphincter dyssynergia (DESD): a systematic review and meta-analysis. Urology. 2020; https://doi.org/10.1016/j.urology.2020.03.007 Abstract Full Text Full Text PDF Scopus (2) Google Scholar However, the review fails to answer some questions that might be central to the lack of widespread adoption of this technique. After all, this was the first urological use of botulinum reported over 3 decades ago. 2 Dykstra DD Sidi AA Scott AB Pagel JM Goldish GD Effects of botulinum a toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol. 1988; 139: 919-922 Crossref PubMed Scopus (379) Google Scholar Currently the molecule is sparingly used for this indication, at a handful of centers, and there is just 1 randomized trial on the subject. 3 Gallien P Reymann JM Amarenco G Nicolas B De Sèze M Bellissant E Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol Neurosurg Psychiatry. 2005; 76: 1670-1676 Crossref PubMed Scopus (101) Google Scholar Compare this with usage of botulinum for overactive bladder and neurogenic detrusor overactivity, 2 other indications with rapid adoption and a large number of high quality studies. 4 Gong QQ Xu YQ Xu J Ding XY Guo C Meta-analysis of randomized controlled trials using botulinum toxin A at different dosages for urinary incontinence in patients with overactive bladder. Front Pharmacol. 2020; 10https://doi.org/10.3389/fphar.2019.01618 Crossref Scopus (12) Google Scholar ,5 Li GP Wang XY Zhang Y Efficacy and safety of onabotulinumtoxinA in patients with neurogenic detrusor overactivity caused by spinal cord injury: a systematic review and meta-analysis. Int Neurourol J. 2018; 22: 275-286 Crossref PubMed Scopus (19) Google Scholar Surely this cannot be a mere lack of awareness of the benefits of this treatment. AUTHOR REPLYUrologyVol. 144PreviewBotulinum toxin A (BoNT-A) is used sparingly in detrusor external sphincter dyssynergia (DESD) and that was the primary reason we conducted this systematic review. DESD is a difficult condition to treat with few treatment options, especially for patients who wish to avoid a lifetime of intermittent catheterization or cannot perform it regularly themselves. Further intermittent catherization itself can be associated with many complications such as an increased risk of urinary tract infections or potential stricture, erosion, or calculus formation with long-term use. Full-Text PDF