Comparative study between botulinium toxin injection and partial division of puborectalis for treating anismus

ABSTRACT

To compare the results of partial division of puborectalis [PDPR] versus local botulinium toxin [BTX-A] injection in treating patients with anismus. This prospective randomized study included 30 male patients with a mean age 38.93 +/- 12.39 years and a mean duration of 5.80 +/- 3.96 years. Diagnosis was made by clinical examination, barium enema, colonoscopy, colonic transit time, anorectal manometry, balloon expulsion test, defecography, and EMG. Patients were randomized into Group [I] included 15 patients injected with BTX-A, and Group [II] included 15 patients who underwent bilateral PDPR. Follow up was conducted for one year. Both BTX-A and PDPR significantly reduced the preoperative constipation scores. The initial and long term success rates were 86.7% and 40% in BTX-A group versus 100% and 66.6% in PDPR group. Recurrence was observed in 7 patients [53.8%] and 5 patients [33.4%] following BTX-A and PDPR respectively. Minor incontinence had occurred in 2 patients [13.3%] following PDPR. BTX-A injection seems to be successful for temporary treatment of anismus. However, PDPR has been found to be a promising method for treatment of anismus with a relatively lower morbidity in relation to its higher success rate