Comparing a transrectal ultrasound-guided with a cystoscopy-guided botulinum toxin a injection in treating detrusor external sphincter dyssynergia in spinal cord injury.

OBJECTIVE: The aim of this study was to compare the results of a transrectal ultrasound-guided botulinum toxin injection with those of a cystoscopy-guided method to the external urethral sphincter in treating detrusor external sphincter dyssynergia. DESIGN: A total of 18 suprasacral spinal cord-injured patients with detrusor external sphincter dyssynergia were included in the present study. A single dose of 100 IU botulinum toxin A was applied into the external urethral sphincter via a transrectal ultrasound-guided transperineal route. We retrospectively compared the outcome measurements with 20 suprasacral spinal cord-injured patients previously treated with the same dose of botulinum toxin through a cystoscopy-guided procedure. RESULTS: There were significant reductions in integrated electromyography and urethral pressure but not in detrusor pressure and leak point pressure after treatment. Postvoiding residuals were significantly decreased in the first, second, and third months in the cystoscopy group and in the first and second months in the transrectal ultrasound group. There were no significant differences between the groups in all of the outcome measures. CONCLUSIONS: This study demonstrates that transrectal ultrasound-guided transperineal botulinum toxin injection may be an alternative for a cystoscopy-guided injection. This alternative procedure provides clinicians with an innovative and less invasive method that is performed without requiring anesthesia or cystoscopy.

Transrectal ultrasound-guided transperineal botulinum toxin a injection to the external urethral sphincter for treatment of detrusor external sphincter dyssynergia in patients with spinal cord injury.

OBJECTIVE: To evaluate the effects of a single transrectal ultrasound (TRUS)-guided transperineal injection of botulinum toxin A (BTX-A) to the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD). DESIGN: Descriptive study. SETTING: Rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Patients (N=18) with suprasacral spinal cord injury who had DESD confirmed on video-urodynamic study. INTERVENTIONS: A single dose of 100U BTX-A was applied into the EUS via TRUS-guided transperineal route injection. MAIN OUTCOME MEASURES: Maximal detrusor pressure, detrusor leak-point pressure, integrated electromyography (iEMG), maximal pressure on static urethral pressure profilometry, and postvoiding residuals. RESULTS: There were significant reductions in iEMG (P=.008) and static (P=.012) and dynamic urethral pressure (P=.023), but not in detrusor pressure and detrusor leak-point pressure after treatment. Postvoiding residuals also significantly decreased in the first and second month after treatment (P<.012). CONCLUSIONS: TRUS-guided transperineal injection of BTX-A has beneficial effects in treating DESD.