Graphique 1 - Faculté de Médecine et de Pharmacie de Fès

efficacy of botulinum injection was demonstrated over a placebo control group.
Toxin was injected at 20 to 30 different sites in the detrusor muscle, with
cystoscopy guidance. Further studies remain necessary regarding the respective
doses of Dysport® and Botox® toxin, the selection of patients, the combination with
anticholinergic treatment and the effects of repeated injections.
Sphincter injections are effective in the short-term treatment of neurogenic
detrusor-sphincter dyssynergia. They have been proposed in neurological patients
unable to perform self-catheterisation, after drug failure and before surgery.
Parameters for results assessment are mostly clinical (increased free interval
between voiding, decreased post-void residual urine volumes), urodynamic
(improvement in bladder emptying, increase in functional bladder capacity and
decrease in urethral pressure) and electromyographic (denervation of striated
urethral sphincter). However, type, dosage and method of use of botulinum toxin
remain very heterogeneous. Both transurethral and transperineal injections
monitored by electromyography are equally effective in improving detrusor-
sphincter dyssynergia.
The efficacy observed during preliminary clinical trials of detrusor injections of
botulinum toxin type A for idiopathic overactive bladder symptoms or interstitial
cystitis and prostatic injections for obstruction related to benign prostatic
hyperplasia justifies the major interest raised by this new therapeutic approach.
However, these preliminary results must be confirmed by comparative studies
on a sufficient number of patients with long-term follow-up before considering the
use of this technique in routine clinical practice.
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