A Comparative Analysis of Paraurethral BoNT-A Injection and Combination Therapy with Alpha-Blocker and Muscle Relaxant for Supra-Sacral Spinal Cord Injury Patients with Detrusor Sphincter Dyssynergia

Introduction: To compare the efficacy of paraurethral BoNT-A injection and a combination of muscle relaxant and alpha-blocker medication in patients with supra-sacral spinal cord injury (SCI) and detrusor sphincter dyssynergia (DSD), as measured by maximum urinary flow rate (Qmax).Methods: This was a randomized, controlled trial conducted over ۶ months. Patients with suprasacral SCI and DSD were randomly assigned to two groups. Group ۱ received intradetrusor BoNT-A injection with a combination of muscle relaxant and alpha-blocker medication, while Group ۲ received concomitant intradetrusor and paraurethral BoNT-A injection. The primary outcome measure was maximum urinary flow rate (Qmax), assessed at baseline and after ۶ months of treatment.Results: This study had ۳۵ patients. At baseline, the mean Qmax in Group ۱ was ۱۲.۶ ml/s, while in Group ۲ it was ۱۳.۲ ml/s. After ۶ months of treatment, the mean Qmax in Group ۱ increased to ۱۶.۵ml/s, while in Group ۲ it increased to ۱۹.۸ml/s (P-value<۰.۰۵).Conclusion: This study suggests that both paraurethral BoNT-A injection and a combination of muscle relaxant and alpha-blocker medication are effective in improving Qmax in patients with suprasacral SCI and DSD. However, paraurethral BoNT-A injection appears to be more effective than the combination of medications in improving Qmax. More research with larger sample sizes are required to prove these findings.

Keywords:

injection , Combination therapy , Alpha-blocker