Predictive Factors for a Successful Treatment Outcome in Patients with Different Voiding Dysfunction Subtypes Who Received Urethral Sphincter Botulinum Injection

Yao-Lin Kao; Yin-Chien Ou; Kuen-Jer Tsai; Hann-Chorng Kuo

doi:10.3390/toxins14120877

Predictive Factors for a Successful Treatment Outcome in Patients with Different Voiding Dysfunction Subtypes Who Received Urethral Sphincter Botulinum Injection

Toxins (Basel). 2022 Dec 15;14(12):877. doi: 10.3390/toxins14120877.

Authors

Yao-Lin Kao¹, Yin-Chien Ou^{1

2}, Kuen-Jer Tsai^{2

3}, Hann-Chorng Kuo⁴

Affiliations

¹ Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
² Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
³ Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan.
⁴ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan.

Abstract

Voiding dysfunction is a common but bothersome problem in both men and women. Urethral sphincter botulinum toxin A (BoNT-A) injections could serve as an option in refractory cases. This study analyzed the efficacy and outcome predictors of the injections in patients with functional, non-neurogenic voiding dysfunction. Patients who received urethral sphincter BoNT-A injection for refractory voiding dysfunction due to detrusor underactivity (DU) or urethral sphincter dysfunction were retrospectively reviewed. A successful outcome was defined as a marked improvement as reported in the global response assessment. The study evaluated the therapeutic efficacy of urethral sphincter BoNT-A injections and measured the changes in urodynamic parameters after the procedure in the patients. A total of 181 patients including 138 women and 43 men were included. The overall success rate was 64%. A lower success rate was noted in patients with DU compared to those with urethral sphincter dysfunction in both genders. In the multivariable analysis, recurrent urinary tract infection (UTI) and bladder voiding efficiency (BVE) were positive predictors for a successful outcome, while DU was a negative predictor. Urethral sphincter BoNT-A injection is an effective treatment for refractory non-neurogenic voiding dysfunction. Baseline BVE and history of recurrent UTI positively predict a successful outcome. DU is a negative outcome predictor.

Keywords: botulinum toxin; detrusor underactivity; urethral; urethral sphincter dysfunction; voiding dysfunction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Botulinum Toxins, Type A* / therapeutic use
Female
Humans
Male
Retrospective Studies
Treatment Outcome
Urethra*
Urinary Bladder
Urodynamics

Substances

Botulinum Toxins, Type A

Grants and funding

The work was supported by grants from the National Cheng Kung University Hospital NCKUH-11103038 and Buddhist Tzu Chi Medical Foundation TCMF-MP-110-03-01 and TCMF-SP-108-01.