Abstract
Although female dysfunctional voiding (DV) is common in urological practice, it is difficult to treat. This study evaluated the therapeutic efficacy of urethral botulinum toxin A (BoNT-A) on non-neurogenic female DV. Based on the videourodynamic study (VUDS), the DV was classified into three subgroups according to the obstructive site. A successful treatment outcome was defined as an improvement of voiding efficiency by 10% and reported global response assessment by ≥1. The study compared therapeutic efficacy, baseline urodynamic parameters, and changes in urodynamic parameters between the treatment success and failure groups and among three DV subgroups. Predictive factors for successful treatment were also investigated. A total of 81 women with DV were categorized into three groups: 55 (67.9%) had mid-urethral DV, 19 (23.5%) had distal urethral DV, and 7 (8.6%) had combined BN dysfunction and mid-urethral DV after BN transurethral incision. The treatment outcome was successful for 55 (67.9%) patients and failed for 26 (32.1%). Successfully treated patients had a significant decrease of detrusor pressure, post-void residual volume, and bladder outlet obstruction index, as well as an increase in voiding efficiency at follow-up versus the treatment failure group. The logistic regression of urodynamic parameters and clinical variables revealed that a greater volume of first sensation of filling predicts a successful BoNT-A treatment outcome (p = 0.047). The urethral BoNT-A injection is effective in treating non-neurogenic women with DV, with a success rate of 67.9%. The videourodynamic characteristics of DV may differ among patients but does not affect the treatment outcome.
Highlights
The pelvic floor function plays an essential role in micturition and defecation [1]
This study retrospectively evaluated the therapeutic efficacy of urethral botulinum toxin A (BoNT-A) on non-neurogenic female dysfunctional voiding (DV) and searched for predictive factors for a successful treatment outcome
No significant difference was noted between the treatment success and failure groups in age distribution, urodynamic parameters, presence of central nervous system lesions, and videourodynamic study (VUDS) subtypes of DV
Summary
The pelvic floor muscles and external urethral sphincter should appropriately relax to facilitate sustained detrusor contraction and complete bladder emptying [2]. When the pelvic floor muscles or urethral sphincter cannot relax during micturition, it is called dysfunctional voiding (DV). The prevalence of female voiding dysfunction is 2.7% to 23% [3,4,5]. In a large cohort of female voiding dysfunction, 17% of patients had DV and 17.6% had poor relaxation of the external sphincter [6]. Among women with clinically unsuspected bladder outlet obstruction (BOO), DV is the most common form of voiding dysfunction [7]. Since female DV might present with storage symptoms rather than voiding symptoms as their chief complaints, DV is commonly mis-diagnosed as an overactive bladder and treated [8]. The accurate diagnosis and treatment is important in this voiding dysfunction
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