An update on the treatment of detrusor-sphincter dyssynergia with botulinum toxin type A

The aim of this study was to evaluate the relaxant effect of two preparations (BOTOX(R) versus Dysport(R)) of botulinum toxin type A (BTX-A) on the external urethral sphincter in patients with neurogenic voiding disorders. Ten male spinal cord injury patients with detrusor-external urethral sphincter dyssynergia (DSD) were clinically assessed before, and 4-6 weeks after, transurethral or transperineal BTX-A injections (BOTOX(R) 100 U or Dysport(R) 250 U) into the external urethral sphincter. Patients with persistent difficulties in voiding or high post-void residual volumes were re-injected with the same product up to three times. All patients were urodynamically examined within 120 days of injection. In total, 30 BTX-A injection cycles (one to three injections) were administered, Significant (P < 0.05) reductions in the DSD duration post-injection, the time interval between the start of bladder contractions and voiding, and DSD severity post-treatment were observed. All patients who presented with a residual volume pre-treatment showed a marked decrease post-treatment. These effects lasted greater than or equal to 6 months. Improvements in urodynamic parameters were significantly better following BOTOX(R) than Dysport(R) treatment (P < 0.05), although the Dysport(R) dose used is now considered less potent than that of BOTOX(R). Thus, injections of BTS-A into the external urethral sphincter are a valuable treatment option for DSD in spinal cord injury patients. Treatment success appears to depend on the severity of DSD before treatment. Eur J Neurol 6 (suppl 4):S83-S89 (C) Lippincott Williams & Wilkins.