Botox urology

Authors Authors and affiliations P. Gallien A.

Durufle B. Nicolas S. Petrilli S. Robineau J. Indication and success of intrasphincter botulinum toxin injection in neurological voiding disorders. This is a preview of subscription content, log in to check access. Jankovic J Botulinum toxin in movement disorders.

Kuo HC Effectiveness of periurethral botulinum toxin injection in the treatment of voiding dysfunction due to detrusor underactivity and non-relaxing urethra. Neurourol Urodyn — Google Scholar. Kuo HC Botulinum A toxin urethral injection for the treatment of lower urinary tract dysfunction. Kuo HC Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction.

Revue de la littérature et recommandations pratiques de suivi. De Seze M, Ruffion A, Denys P, et al Les vessies neurologiques et leurs complications dans la sclérose en plaques: revue de la littérature. Schurch B, Hauri D, Rodic B, et al Botulinum A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients.

J Urol — Google Scholar. Phelan MW, Franks M, Somogyi GT, et al Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. Chen YH, Kuo HC Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions.

Rackley R, Abdelmalak J Urologic applications of botulinum toxin therapy for voiding dysfunction. Gallien P, Verin M, Robineau S, et al Intérêt de la toxine botulinique dans le traitement des dyssynergies vésicosphinctériennes. Gallien P, Reymann JM, Amarenco G, et al Placebocontrolled, randomized, double-blind study of botulinum A toxin in the treatment of detrusor-sphincter dyssynergia inmultiple sclerosis patients. Gallien P, Robineau S, Verin M, et al Treatment of detrusor-sphincter dyssynergia by transperineal injection of botulinum toxin.

De Sèze M, Petit H, Gallien P, et al Botulinum A Toxin and detrusor sphincter dyssynergia, a double blind lidocaine controlled study in 13 patients with spinal cord disease.

Blaivas JG, Barbalias GA Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition. Franco I, Landau-Dyer L, Isom-Batz G, et al The use of botulinum toxin A injection for the management of external sphincter dyssynergia in neurologically normal children. The criteria used to evaluate the efficacy of botulinum toxin in this situation vary considerably from one group to another.

This latter method of leakage quantification must, however, be used with caution, since it has not been validated for urge incontinence.

Urodynamic parameters are also used to evaluate the effect of the toxin on bladder function, both in terms of efficacy and safety of use risk of retention.

Other urodynamic parameters such as the maximum urinary flow rate and bladder contractility are monitored to detect possible complications of treatment with botulinum toxin. InSchmid et al. The dose injected avoiding the trigone was U.

The absence of clinical and urodynamic improvement was noted in eight patients who initially had compliance disorders. This study had the advantage of being prospective and investigated a large number of patients.

Sahai is one of the few authors to have performed a randomized, placebo-controlled study. Botulinum toxin injection into the detrusor: an effective treatment in idiopathic and neurogenic detrusor overactivity? The results were judged to be excellent i. Five patients felt better after treatment. However, the improvement in urodynamic parameters seen three and six months after treatment was not always statistically significant. In this study, the use of a rigid fibre-optic endoscope prevented injection into the anterior bladder wall leading to heterogeneous distribution of the toxin within the detrusor and may thus have biased the study results.

Efficacy of botulinum toxin A in the treatment of detrusor overactivity incontinence. The urodynamic data reported by Schmid et al. The treatment remained effective for five to nine months Table 2.

Is the bladder a reliable witness for predicting detrusor overactivity? However, the performance of a urodynamic status check before and after treatment can be justified when seeking to identify patients who are not likely to respond to botulinum toxin treatment or those likely to present side effects and thus require close monitoring.

Large-scale, long-term clinical and urodynamic follow-up could help better identify factors that are predictive of the success or failure of botulinum toxin treatment.

In fact, in the absence of a comparative study of patients with or without detrusor overactivity, it is not possible to tell whether this latter factor is predictive of success or failure. Overactivity syndrome can lead to depression, sexual disorders, sleep disorders and absenteeism from work. Hence, it can have a clearly negative impact on quality of life. Kalsi et al. The results were compared with cystometric and voiding diary data.

Fourchette et bikini maigrir des cuisses

This effect lasted for nine months and then declined. Grosse et al. No other authors have reported this complication with the doses used in non-neurological patients. A risk of bladder hypocontractility and thus urine retention and the need for self-catheterization has also been reported in the literature [2,18,22,28,33,39]. Sahai et al. Furthermore, the patient inclusion and exclusion criteria in the various studies may also give rise to bias and prevent intertrial comparisons.

The studies also differed in terms of the injection sites and the equipment used. Lastly, the toxin dose and dilution also varied from one study to another. Treatment with anticholinergic agents remains the front-line treatment for NNDO.

It must be attempted with a single drug or a combination, in view of the risk of intensifying the side effects. Furthermore, new treatments and novel drugs for modulating urothelial sensitivity are under development. The intradetrusor injection of botulinum toxin A for the symptomatic treatment of NNDO has yielded encouraging preliminary results.

Side effects are infrequent and primarily consist of the dose-dependent risk of urine retention. At present, this therapeutic technique should only be used in clinical research protocols. In fact, many aspects remain to be elucidated, such as the minimal optimal dose and the risk factors for failure or the occurrence of adverse events. Le retentissement sociopsychologique parfois majeur de cette pathologie justifie une prise en charge thérapeutique adaptée.

Dyskra et al. Cela évoque donc un double effet à la fois sur la partie efférente du réflexe mictionnel, mais aussi sur la régulation du message afférent.

Les injections intradétrusoriennes de la toxine botulique sont réalisées en ambulatoire ou en hospitalisation de jour. Les urines doivent être stériles. Les injections sont réalisées dans la partie superficielle du muscle détrusor. La procédure dure généralement 20 minutes.

Les injections ont été décrites initialement en intramusculaire par assimilation aux autres indications dans le muscle strié. Son effet se maintient entre six et neuf mois selon les études. Au total, 19 études ont été réalisées. Schmid et al. La dose injectée était de U en évitant le trigone.

Cinq patients se sont sentis améliorés. Les données urodynamiques ont montré à six semaines pour Schmid et al. Cependant, la réalisation du bilan urodynamique avant et après traitement peut être justifiée pour identifier les patients susceptibles de ne pas répondre au traitement par toxine botulique ou ceux pouvant présenter des effets secondaires et motivant une surveillance étroite.

Il peut avoir de ce fait un impact négatif reconnu sur la qualité de vie. Les résultats ont été comparés aux donnés du catalogue mictionnel et de la cystomanométrie. De même, Schmid et al. Quatre-vingt-dix pour cent des patients ont rapporté une amélioration dans au moins une des catégories du king health questionnaire capacité à travailler, sommeil, participation sociale, accomplissement de taches de la vie quotidienne et effet global sur la vie de tous les jours.

Cet effet a duré neuf mois puis a régressé. Les effets secondaires de la toxine botulique sont rares. Les sites injectés sont également différents entre les études et pour certaines dépendent du matériel utilisé.

Il doit être tenté seul ou en association en tenant compte du risque de majoration des effets secondaires. Français Español Italiano.

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