Concomitant Detrusor and External Urethral Sphincter Botulinum Toxin-A Injections in Male Spinal Cord Injury Patients with Detrusor Overactivity and Detrusor Sphincter Dyssynergia.
Yu-Hui Huang, Sung-Lang Chen
PMID 35174865WHAT IT FOUND
Detrusor and sphincter botulinum toxin injections lowered bladder and urethral pressures and increased capacity in 20 men with spinal cord injury, while catheter frequency, diaper use, and residual urine ratio stayed similar.
Key findings
01Concomitant botulinum toxin injections into the detrusor and external urethral sphincter reduced maximal detrusor pressure from 100 to 68 cmH2O and maximal urethral pressure from 98 to 79 cmH2O at 12 weeks.
02Bladder capacity increased from 293 to 384 mL at 12 weeks, but post-void residual urine did not increase significantly (244 vs 301 mL; p = 0.108).
03UDI-6 scores improved at 4 and 12 weeks, IIQ-7 scores improved at 12 weeks, and catheter frequency and diaper pad use did not change significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 20 men were studied, and there was no comparison group, so improvement cannot be confidently attributed to the injections. All participants stopped oral bladder and sphincter medications before and during follow-up, so the effect of the injections cannot be separated from medication withdrawal. The participants were selected because they were unwilling or unable to increase catheter frequency, so the results do not apply broadly to people with spinal cord injury bladder dysfunction. Detailed urodynamic testing was done only at baseline and 12 weeks, so longer-term effects on the bladder and sphincter were not measured. Some diary and questionnaire benefits were not statistically clear at 24 weeks, so durability is uncertain.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as proof that combined botulinum toxin injections work for all spinal cord injury patients with bladder dysfunction. The study had only 20 selected men, no control group, and all patients stopped oral bladder medications, so the effect of the injections alone cannot be separated.