Treatment of Detrusor External Sphincter Dyssynergia Using Ultrasound-Guided Trocar Catheter Transurethral Botulinum Toxin A Injection in Men With Spinal Cord Injury

Objective: To evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI). Design: Descriptive study. Setting: Hospital rehabilitation department. Participants: Patients (N=15; mean age, 40.5y; range, 22-64y) with suprasacral SCI with confirmed DESD determined by urodynamic study. Interventions: A single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection. Main Outcome Measures: Maximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate. Results: After BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure (P<.05) and detrusor leak point pressure after treatment (P<05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment (P<.05). Conclusions: Transrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the BUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection. Archives of Physical Medicine and Rehabilitation 2015;96:614-9 (C) 2015 by the American Congress of Rehabilitation Medicine