Transuethral injection of botulinum A toxin into the urethral sphincter in patients with functional bladder outlet obstruction

Botulinum A toxin [BTX-A] injection into the external urinary sphincter has been reported in men with detrusor-sphincter dyssynergia [DSD] in few recent studies. Botulinum A toxin injection into external urethral sphincter to paralyze it and to relieve urethral obstruction was reported as a new mode of treatment to reduce infra-vesical resistance in cases of functional obstruction. The present study investigated the effect of injection of Botulinum A toxin into the external urinary sphincter to improve voiding in patients with functional bladder outlet obstruction. 7 patients [78%] showed a significant subjective and objective improvement in voiding patterns compared to that of their pre-operative condition. Botulinium toxin injection is a safe, reversible, conserative option in the treatment of functional infra-vesical obstruction. The effect of the toxin is of short-duration and requires successive injections before reaching a satisfactory long-term improvement in voiding pattern

Etiological factors in urinary incontinence in elderly female patients

Thirty incontinent women [above 60 years] were evaluated by full history, physical examination, voiding diary and full urodynamic studies. Another, 10 post menopausal women were studied as a control. Urodynamic data did not correlate with patient's symptomatology. No significant abnormal urodynamic data were encountered in control group. Females with urge incontinence showed detrusor instability in 53.8%, hypocompliance in 46.2% and higher level of infravesical urethral resistance than other types of incontinence, genuine stress incontinence was present in only 13.3% of patients, the above data point to the importance of studying elderly incontinent females urodynamically to establish the exact underlying defect