mentions CMT-Botulinic toxin in patients with neurogenic dysfunction of the lower urinary tracts

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Abstract from Urologiia. 2004 Jul-Aug;(4):44-8

Botulinic toxin in patients with neurogenic dysfunction of the lower urinary

tracts [Article in Russian]

[No authors listed]

Botulinic toxin (BT) is a new method of lowering intraurethral pressure in

symptoms of obstructive voiding in patients with neurogenic dysfunction of the

lower urinary tracts (LUT). Transperineal introduction of 100 units of BT type A

(botox, Allergan) was used under electromyographic control into the external

urethral sphincter of 9 patients (6 males and 3 females) with LUT neurogenic

dysfunction aged 17 to 68 years (mean age 37.2 years). Two patients had

subnormal detrusor contractility due to myelodysplasia and diabetic

polyneuropathy, two other patients--non-incontinent striated urethral sphincter

after hemorrhagic stroke and spinal contusion, five patients suffered from

detrusor-sphincteral dyssynergia (DSD) resultant from Schmorl's hernia, multiple

sclerosis, Charcot-Marie disease and ischemic stroke of the spinal cord. Three

patients had cystostomic drainage. The rest of the patients complained of

dysuria, three patients performed self-catheterization, mean volume of the

residual urine was 170 ml (180-240 ml). In 10 days residual urine was not found

in 2 patients with subnormal detrusor contractility and in 4 patients with DSD.

Abdominal pressure fell from 75 to 39 cm, on the average. In DSD patients

maximal detrusor pressure fell from 59 to 29 cm, on the average. Mean maximal

urinary flow rate rose from 4.3 to 9.6 ml/s. In 20 days, on the average,

suprapubic fistula healed in all the patients. In a month, therapeutic effect

persisted in all the patients. Complications, side effects were not registered.

BT treatment to induce adequate urine evacuation in neurological patients is a

promising approach in neurourology. Further studies should find answers to

questions about regimen of BT introduction, loss of sensitivity, new indications

in urology.

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