Effect of anal stretch and botulinum toxin injection on detrusor-external sphincter dyssynergia: evaluated by integrated electromyography
| Autor: | Yu-Hui, 黃玉慧 |
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| Rok vydání: | 2008 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 96 Detrusor-external sphincter dyssynergia (DESD) is a common cause of bladder outlet obstruction in SCI patients and associated with many urologic complications. Sphincterotomy is currently the main treatment of DESD, but its irreversability, high failure rate and high re-operation rate make it not so acceptable to most SCI patients. The other treatment choices are urethral stent, urethral ballon dilatation, oral medication, pudendal nerve block, anal stretch and botulinum toxin injection. Among these methods, anal stretch and botulinum toxin injection are two methods that are reversible, easy to perform, and with no serious side effects. Anal stretch was reported to effectively inhibit activity of external urethral sphincter in patients with DESD. However the opinions of effects on detrusor are controversial and there were no further studies since 1981. Botulinum –A toxin injection to the external urethral sphincter could reduce post-voiding residual urine amounts and improve urodynamic parameters (detrusor pressure and urethral pressure) in previous reports. However these parameters could be influenced by other factors and the direct evaluation of urethral sphincter activity from electromyography was only descriptive without quantification in these studies. In this study, we further investigated these two treatments by using integrated electromyography (IEMG) to quantify the activity of external urethral sphincter. With direct evidences of effect, we could choose the prompt patients to receive these treatments, then we can improve the clinical efficiency. In the results of anal stretch, it could significantly reduce the activity of external urethral sphincter showed on IEMG (the mediums of reduction percentage during 1- 15 seconds and 16-30 seconds were 33% and 35%). The urethral pressure was also reduced but the difference was significant only between the data before stretch and at 16-30 seconds after stretch. The detrusor pressure did not change significantly. Patients with different ASIA impairment scale had different responses: the more completeness of neurologic injury (Grade A and B in ASIA impairment scale), the better effect of anal stretch. In the results of botulinum toxin injection, there were significant reductions in IEMG and static and dynamic urethral pressure (mean reduction percentages were 24.4, 20.6, and 17.3, respectively) but not in maximal detrusor pressure and leak point pressure at one month after treatment. PVR was significantly decreased at the all of the evaluation periods (mean reduction percentages were 41.2, 32.6, 24.6, and 15.8, at month 1, 2, 3, and 6 after treatment). In the sub-group analysis, patients with good effect had significantly lower baseline IEMG (p |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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