Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease

We studied the efficacy of endoscopic injection of Botulinum A toxin (150 I.U. Dysport) in the treatment of detrusor-sphincter dyssynergia in 17 patients with spinal cord disease. One month after the injection, the postvoiding residual urine volume (-176 ml, P < 0.001), the bladder pressure on voiding (-19 cm water, P < 0.01), and the urethral pressure (-24 cm water, P < 0.001) were significantly decreased. The modality of voiding was improved in 10 patients (i.e. micturition by suprapubic tapping was easier to induce, discontinuation of indwelling catheter use, or decrease in frequency of intermittent catheterizations). The tolerance of the treatment was excellent. The therapeutic effect lasted 2 to 3 months on the average. The low doses used in this study probably explain in part why the treatment sometimes failed. Botulinum A toxin could become an alternative treatment for detrusorsphincter dyssynergia in certain patients, notably in those who are refractory to sphincterotomy or in patients, such as those who are tetraplegic, and who are incapable of performing intermittent self-catheterization.