RESUMO
Fundamento y objetivo: Evaluar la eficacia y seguridad de la toxina botulínica en la hipertonía esfinteriana en pacientes con lesión medular (LM). Pacientes y método: Ensayo clínico no controlado en varones con hipertonía esfinteriana secundaria a LM. Se aplicaron 100 U de Botox® vía transperineal en esfínter uretral externo guiado con electromiografía y ecografía transrectal. Se determinaron los siguientes parámetros: volumen urinario residual (VR), presión uretral máxima de cierre (PUMc), volumen de micción (M) y porcentaje de micción (MP). Se valoró la incidencia de disfunción eréctil mediante cuestionario International Index of Erectil Function (IIEF-5 items). Resultados: Se incluyeron 19 varones, con una media de edad de 40 años (extremos 22-56). El tiempo medio de seguimiento fue de 546 días (20 meses). Se realizó una infiltración cada 6 meses de promedio, con una media de 2,7 infiltraciones por paciente (extremos 1-7). El VR disminuyó 59,3ml (p=0,03), la micción aumentó 52ml (p=0,018) y el MP mejoró el 17,2% (p=0,011), mientras que los cambios en PUMc no fueron significativos. No empeoró la disfunción eréctil presentada ya previamente (IIEF-5: 11,4 a 13). Conclusión: La infiltración con toxina botulínica aplicada a esfínter uretral externo vía transperineal parece ser una eficaz y segura opción terapéutica (AU)
Background: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI). Patients and methods: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items). Results: 19 men with an average age of 40years (ED 22-56) were included. The average time of monitoring was 546days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3ml, p=0.03; miction raised to 52ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13). Conclusion: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option (AU)
Assuntos
Humanos , Masculino , Toxinas Botulínicas/uso terapêutico , Retenção Urinária/terapia , Uretra , Traumatismos da Medula Espinal/complicaçõesRESUMO
BACKGROUND: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI). PATIENTS AND METHODS: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items). RESULTS: 19 men with an average age of 40 years (ED 22-56) were included. The average time of monitoring was 546 days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3 ml, p=0.03; miction raised to 52 ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13). CONCLUSION: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option.
