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Comparing a Transrectal Ultrasound-Guided with a Cystoscopy-Guided Botulinum Toxin A Injection in Treating Detrusor External Sphincter Dyssynergia in Spinal Cord Injury

Chen, Sung-Lang MD, PhD; Bih, Liu-Ing MD; Chen, Gin-Den MD; Huang, Yu-Hui MD, PhD; You, Ya-Hui RN

American Journal of Physical Medicine & Rehabilitation: September 2011 - Volume 90 - Issue 9 - pp 723-730
doi: 10.1097/PHM.0b013e31821a72a3
Original Research Articles: SCI

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.

From the Departments of Urology (S-LC), Physical Medicine and Rehabilitation (L-IB, Y-HH), Obstetrics and Gynecology (G-DC), Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung (S-LC, L-IB, G-DC, Y-HH); and Department of Nursing, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan (Y-HY).

All correspondence and requests for reprints should be addressed to: Yu-Hui Huang, MD, PhD, Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, #110, Chien-Kuo North Road, Section 1, Taichung 402, Taiwan.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2011 Lippincott Williams & Wilkins, Inc.