Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors
Abstract
1. Introduction
2. Results
3. Discussion
4. Conclusions
5. Materials and Methods
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
BN | Bladder neck | BOOI | Bladder outlet obstruction index |
CBC | Cystometric bladder capacity | DHIC | Detrusor hyperactivity with impaired contractility |
DO | Detrusor over-activity | DSD | Detrusor sphincter dyssynergia |
DU | Detrusor under-activity | DV | Dysfunctional voiding |
FS | Full sensation | FSF | The first sensation of filling |
Pdet | Detrusor pressure at the maximum flow rate | PRES | Poor relaxation of the external sphincter |
PVR | Post-void residual volume | Qmax | Maximal flow rate |
UFR | Uroflowmetry | US | Urge sensation |
VE | Voiding efficiency | vUDS | Video-urodynamic studies |
VV | Voiding volume |
Good Outcome (N = 71) | Poor Outcome (N = 35) | p | |
---|---|---|---|
Age | 62.6 ± 18.8 | 60.2 ± 21.8 | 0.553 |
HT | 30 (42%) | 11 (31%) | 0.282 |
DM | 23 (32%) | 8 (23%) | 0.310 |
CKD | 3 (4%) | 3 (9%) | 0.362 |
COPD | 0 (0%) | 3 (9%) | 0.034 * |
CAD | 6 (9%) | 1 (3%) | 0.421 |
Neurogenic history a | 31 (44%) | 18 (51%) | 0.451 |
Catheterization b | 24 (34%) | 18 (51%) | 0.081 |
DV | 17 (24%) | 6 (17%) | 0.404 |
DSD | 10 (14%) | 9 (26%) | 0.152 |
PRES | 43 (61%) | 20 (57%) | 0.673 |
DO | 27 (38%) | 11 (31%) | 0.505 |
DU | 30 (42%) | 15 (43%) | 0.953 |
DHIC | 11 (16%) | 3 (9%) | 0.379 |
Narrow BN | 19 (27%) | 16 (46%) | 0.051 |
UFR parameters | |||
Qmax | 6.5 ± 4.6 | 7.6 ± 4.8 | 0.241 |
Voiding volume | 112.3 ± 94.7 | 145.5 ± 103.2 | 0.104 |
PVR (≥230 mL) | 27 (38%) | 10 (29%) | 0.337 |
CBC (≥350 mL) | 29 (41%) | 14 (40%) | 0.934 |
VE | 0.36 ± 0.25 | 0.50 ± 0.28 | 0.015 * |
vUDS parameters | |||
FSF | 145.8 ± 93.3 | 123.8 ± 56.3 | 0.202 |
FS | 218.9 ± 109.2 | 188.1 ± 78.9 | 0.139 |
US | 254.3 ± 123.1 | 209.5 ± 92.5 | 0.060 |
Compliance | 79.0 ± 116.1 | 58.6 ± 73.1 | 0.345 |
Pdet | 28.5 ± 29.2 | 24.1 ± 25.4 | 0.445 |
Qmax | 5.4 ± 4.6 | 4.8 ± 5.0 | 0.560 |
BOOI | 17.7 ± 29.7 | 14.5 ± 28.0 | 0.588 |
PVR | 276.1 ± 196.0 | 181.7 ± 139.7 | 0.005 * |
CBC | 379.8 ± 172.0 | 294.4 ± 180.1 | 0.020 * |
VE | 0.32 ± 0.28 | 0.34 ± 0.27 | 0.679 |
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Idiopathic Sphincter Dysfunction (N = 56) | Neurogenic Sphincter Dysfunction (N = 50) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
DV (N = 23) | PRES (N = 33) | p | DSD (N = 20) | PRES (N = 30) | p | |||||
HT | 4 | (17%) | 17 | (52%) | 0.012 * | 8 | (40%) | 12 | (40%) | 1.000 |
DM | 4 | (17%) | 8 | (24%) | 0.743 | 9 | (45%) | 11 | (37%) | 0.556 |
CKD | 0 | (0%) | 2 | (6%) | 0.507 | 1 | (5%) | 3 | (10%) | 0.641 |
COPD | 1 | (4%) | 0 | (0%) | 0.411 | 2 | (10%) | 0 | (0%) | 0.155 |
CAD | 0 | (0%) | 4 | (12%) | 0.136 | 2 | (10%) | 1 | (3%) | 0.556 |
Cathterization a | 12 | (52%) | 9 | (27%) | 0.058 | 8 | (40%) | 13 | (43%) | 0.815 |
Baseline UFR Parameters | ||||||||||
VV | 139.7 | ±94.3 | 130.5 | ±125.6 | 0.770 | 107.9 | ±68.5 | 109.4 | ±85.3 | 0.946 |
Qmax | 7.3 | ±3.2 | 7.4 | ±5.4 | 0.941 | 7.6 | ±5.9 | 5.4 | ±3.7 | 0.156 |
PVR | 160.8 | ±98.5 | 188.1 | ±147.5 | 0.443 | 208.9 | ±196.3 | 258.5 | ±151.1 | 0.318 |
CBC | 300.4 | ±135.4 | 318.7 | ±127.8 | 0.617 | 316.7 | ±195.3 | 367.9 | ±167.2 | 0.326 |
VE | 0.47 | ±0.23 | 0.43 | ±0.32 | 0.611 | 0.44 | ±0.26 | 0.31 | ±0.22 | 0.067 |
Baseline vUDS Parameters | ||||||||||
DO | 19 | (83%) | 0 | (0%) | <0.001 * | 15 | (75%) | 3 | (10%) | <0.001 * |
DU | 1 | (4%) | 20 | (61%) | <0.001 * | 3 | (15%) | 21 | (70%) | <0.001 * |
DHIC | 2 | (9%) | 6 | (18%) | 0.449 | 0 | (0%) | 6 | (20%) | 0.069 |
Narrow BN | 6 | (26%) | 12 | (36%) | 0.418 | 4 | (20%) | 12 | (40%) | 0.137 |
FSF | 117.8 | ±82.5 | 154.7 | ±67.6 | 0.072 | 106.7 | ±52.5 | 159.4 | ±106.0 | 0.045 * |
FS | 184.4 | ±86.0 | 244.8 | ±92.0 | 0.016 * | 166.8 | ±101.8 | 217.7 | ±107.5 | 0.101 |
US | 218.3 | ±108.2 | 283.5 | ±109.2 | 0.032 * | 183.0 | ±114.2 | 249.5 | ±110.0 | 0.045 * |
CBC | 335.5 | ±119.0 | 390.6 | ±208.0 | 0.257 | 280.0 | ±202.0 | 365.8 | ±157.1 | 0.098 |
Compliance | 82.8 | ±113.1 | 81.3 | ±84.1 | 0.953 | 59.8 | ±118.6 | 62.3 | ±109.6 | 0.940 |
Idiopathic Voiding Dysfunction (N = 56) | Neurogenic Voiding Dysfunction (N = 50) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
DV (N = 23) | PRES (N = 33) | pa | DSD (N = 20) | PRES (N = 30) | pa | ||||||
Good sub. Outcome | 15 | (65%) | 21 | (64%) | 0.903 | 15 | (75%) | 20 | (67%) | 0.529 | |
Good obj. Outcome | 17 | (74%) | 22 | (67%) | 0.562 | 10 | (50%) | 21 | (70%) | 0.220 | |
UFR Parameters | |||||||||||
Qmax | B | 7.3 | ±3.2 | 7.4 | ±5.4 | 0.980 | 8.3 | ±5.9 | 5.4 | ±3.7 | 0.800 |
P | 10.2 ** | ±5.7 | 10.2 * | ±7.7 | 10.8 | ±8.6 | 9.1 ** | ±7.2 | |||
VV | B | 139.7 | ±94.3 | 130.5 | ±125.6 | 0.559 | 109.7 | ±69.9 | 109.4 | ±85.3 | 0.921 |
P | 174.7 | ±104.7 | 190.9 | ±124.6 | 125.1 | ±73.7 | 122.8 | ±80.7 | |||
PVR | B | 160.8 | ±98.5 | 188.1 | ±147.5 | 0.657 | 209.7 | ±201.6 | 258.5 | ±151.1 | 0.802 |
P | 134.1 | ±99.4 | 171.0 | ±221.8 | 144.5 | ±142.3 | 176.9 | ±191.6 | |||
CBC | B | 300.4 | ±135.4 | 318.7 | ±127.8 | 0.328 | 319.4 | ±200.3 | 367.9 | ±167.2 | 0.831 |
P | 308.8 | ±118.9 | 360.4 | ±203.5 | 269.6 | ±161.7 | 299.6 | ±188.1 | |||
VE | B | 0.47 | ±0.23 | 0.43 | ±0.32 | 0.616 | 0.45 | ±0.26 | 0.31 | ±0.22 | 0.579 |
P | 0.59 ** | ±0.30 | 0.60 ** | ±0.32 | 0.53 | ±0.27 | 0.52 ** | ±0.31 | |||
vUDS Parameters | |||||||||||
FSF | B | 117.7 | ±89.6 | 164.4 | ±74.3 | 0.086 | 109.4 | ±49.7 | 142.9 | ±61.0 | 0.710 |
P | 110.4 | ±69.8 | 151.8 | ± 72.4 | 117.5 | ±56.7 | 134.2 | ±48.5 | |||
FS | B | 191.7 | ±90.9 | 250.3 | ± 108.3 | 0.023 | 180.4 | ±116.5 | 200.7 | ±68.5 | 0.700 |
P | 163.3 | ±77.4 | 251.7 | ± 109.8 | 170.8 | ±56.6 | 183.0 | ±75.7 | |||
US | B | 228.9 | ±111.9 | 286.3 | ± 127.0 | 0.004 | 195.3 | ±129.4 | 237.8 | ±80.3 | 0.600 |
P | 180.3 | ±83.4 | 293.8 | ±114.1 | 187.4 | ±65.6 | 208.6 | ±92.1 | |||
Compliance | B | 92.4 | ±125.4 | 74.4 | ±87.5 | 0.194 | 75.8 | ±151.6 | 49.3 | ±66.9 | 0.540 |
P | 44.5 | ±35.6 | 65.5 | ±66.4 | 35.6 | ±21.9 | 29.0 | ±19.6 | |||
Pdet | B | 53.6 | ±29.0 | 13.0 | ±11.9 | 0.136 | 42.1 | ±23.5 | 8.3 | ±11.6 | 0.635 |
P | 51.1 | ±31.2 | 11.9 | ±15.4 | 31.2 | ±15.4 | 17.3 | ±19.1 | |||
Qmax | B | 5.8 | ±2.5 | 4.2 | ±5.4 | 0.334 | 6.3 | ±5.4 | 2.6 | ±3.5 | 0.809 |
P | 6.3 | ±4.3 | 6.7 | ±6.6 | 7.5 | ±10.3 | 5.1 | ±6.1 | |||
BOOI | B | 41.9 | ±30.8 | 4.6 | ±11.3 | 0.116 | 29.4 | ±29.8 | 3.2 | ±13.5 | 0.421 |
P | 38.5 | ±33.0 | -1.5 | ±15.9 | 16.2 | ±19.8 | 7.2 | ±24.8 | |||
PVR | B | 217.2 | ±128.2 | 314.3 | ±248.6 | 0.118 | 249.2 | ±235.5 | 306.2 | ±150.3 | 0.970 |
P | 174.4 | ±135.9 | 305.2 | ±263.1 | 248.3 | ±209.4 | 275.7 | ±196.8 | |||
CBC | B | 340.5 | ±126.7 | 402.8 | ±237.1 | 0.044 | 347.8 | ±222.3 | 366.4 | ±165.7 | 0.264 |
P | 303.9 | ±141.6 | 430.0 | ±198.3 | 323.1 | ±183.9 | 393.0 | ±169.8 | |||
VE | B | 0.40 | ±0.22 | 0.22 | ±0.27 | 0.769 | 0.34 | ±0.26 | 0.14 | ±0.18 | 0.676 |
P | 0.47 | ±0.33 | 0.39 | ±0.38 | 0.35 | ±0.37 | 0.31 * | ±0.37 |
Good Outcome (N = 71) | Poor Outcome (N = 35) | p | |
---|---|---|---|
Age | 61.5 ± 18.9 | 62.4 ± 21.3 | 0.814 |
HT | 28 (39%) | 14 (39%) | 0.956 |
DM | 24 (34%) | 8 (22%) | 0.216 |
CKD | 4 (6%) | 2 (6%) | 1.000 |
COPD | 2 (3%) | 1 (3%) | 1.000 |
CAD | 5 (7%) | 2 (6%) | 1.000 |
Neurogenic history a | 35 (49%) | 15 (42%) | 0.455 |
Catheterization b | 20 (28%) | 22 (61%) | 0.001 * |
DV | 15 (21%) | 8 (23%) | 0.839 |
DSD | 15 (21%) | 5 (14%) | 0.397 |
PRES | 41 (58%) | 22 (63%) | 0.614 |
DO | 26 (37%) | 12 (33%) | 0.737 |
DU | 29 (41%) | 16 (44%) | 0.722 |
DHIC | 9 (13%) | 5 (14%) | 1.000 |
Narrow BN | 6 (9%) | 29 (81%) | <0.001 * |
UFR parameters | |||
Qmax | 7.3 ± 4.7 | 5.8 ± 4.4 | 0.096 |
Voiding volume | 129.5 ± 103.7 | 109.5 ± 85.3 | 0.327 |
PVR (≥230 mL) | 17 (24%) | 20 (56%) | 0.001 * |
CBC (≥350 mL) | 21 (30%) | 22 (61%) | 0.002 * |
VE | 0.44 ± 0.26 | 0.35 ± 0.27 | 0.089 |
vUDS parameters | |||
FSF | 148.4 ± 92.2 | 118.7 ± 56.7 | 0.080 |
FS | 218.7 ± 107.0 | 187.6 ± 84.0 | 0.130 |
US | 251.4 ± 120.9 | 215.8 ± 99.4 | 0.130 |
Compliance | 78.6 ± 116.3 | 58.1 ± 72.0 | 0.335 |
Pdet | 28.9 ± 29.6 | 22.8 ± 24.0 | 0.285 |
Qmax | 5.7 ± 5.1 | 4.2 ± 3.7 | 0.095 |
BOOI | 17.6 ± 30.7 | 14.4 ± 25.6 | 0.567 |
PVR | 226.8 ± 178.5 | 279.4 ± 190.2 | 0.162 |
CBC | 339.9 ± 172.1 | 372.2 ± 189.3 | 0.376 |
VE | 0.35 ± 0.30 | 0.27 ± 0.22 | 0.090 |
Univariate Analysis | Multivariate Analysis | |||||||
---|---|---|---|---|---|---|---|---|
OR | 95% CI | 95% CI | p | OR | 95% CI | 95% CI | p | |
Age | 0.99 | 0.98 | 1.02 | 0.812 | ||||
Neurogenic history a | 1.361 | 0.61 | 3.06 | 0.455 | ||||
Catheterization b | 0.25 | 0.11 | 0.58 | 0.001 * | 0.20 | 0.05 | 0.85 | 0.029 * |
DV | 0.90 | 0.34 | 2.39 | 0.839 | ||||
DSD | 1.61 | 0.53 | 4.85 | 0.400 | ||||
PRES | 0.81 | 0.35 | 1.86 | 0.615 | ||||
Narrow BN | 0.02 | 0.01 | 0.07 | <0.001 * | 0.02 | 0.00 | 0.07 | <0.001 * |
PVR (≥230 mL) | 0.25 | 0.11 | 0.59 | 0.002 * | 0.33 | 0.05 | 2.24 | 0.254 |
CBC (≥350 mL) | 0.27 | 0.12 | 0.62 | 0.002 * | 0.88 | 0.15 | 5.33 | 0.888 |
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Ou, Y.-C.; Huang, K.-H.; Jan, H.-C.; Kuo, H.-C.; Kao, Y.-L.; Tsai, K.-J. Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors. Toxins 2021, 13, 398. https://doi.org/10.3390/toxins13060398
Ou Y-C, Huang K-H, Jan H-C, Kuo H-C, Kao Y-L, Tsai K-J. Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors. Toxins. 2021; 13(6):398. https://doi.org/10.3390/toxins13060398
Chicago/Turabian StyleOu, Yin-Chien, Kuan-Hsun Huang, Hau-Chern Jan, Hann-Chorng Kuo, Yao-Lin Kao, and Kuen-Jer Tsai. 2021. "Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors" Toxins 13, no. 6: 398. https://doi.org/10.3390/toxins13060398
APA StyleOu, Y.-C., Huang, K.-H., Jan, H.-C., Kuo, H.-C., Kao, Y.-L., & Tsai, K.-J. (2021). Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors. Toxins, 13(6), 398. https://doi.org/10.3390/toxins13060398