[Efficacy and safety of botulinum toxin in external urethral sphincter by transperineal way guided transrectal ultrasound and electromyography on chronic urinary retention due to spinal cord injury]

Abstract

Background: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI).

Patients and methods: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items).

Results: 19 men with an average age of 40 years (ED 22-56) were included. The average time of monitoring was 546 days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3 ml, p=0.03; miction raised to 52 ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13).

Conclusion: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option.