Botulinum A

Botulinum A toxin inhibits the release of acetylcholine from the presynaptic neuromuscular junction that leads to muscle relaxation. The actions are temporary because axonal regeneration occurs in approximately 3 to 6 months. Botulinum A toxin has been used in patients with detrusor sphincter dyssynergia and refractory overactive bladder. Two studies have reported the use of botulinum A in patients with voiding dysfunction. Phelan et al.13 performed a prospective evaluation of the injection of 80 to 100U of botulinum A into the external urethral sphincter in 8 men and 13 women with voiding dysfunction secondary to neurogenic detrusor sphincter dyssynergia, pelvic floor spasticity, or an acontractile bladder. All patients except one were able to void spontaneously, and all but two were able to discontinue the use of catheterization.

Kuo14 evaluated the effect of 50U of botulinum A toxin injection in 20 patients (16 women) with voiding dysfunction. Fifteen patients had an areflexic bladder and five had dysfunctional voiding. After injection, 11 patients could void by abdominal straining without the use of a catheter and 7 patients urinated with less difficulty than they had previously. Voiding pressure, maximal urethral closing pressure, and PVR decreased in 90% of the patients. These patients showed improvement in symptoms scores and quality of life at 3 months.

One double-blind controlled study evaluated the efficacy of botulinum A toxin versus lidocaine in 13 patients with detrusor sphincter dyssynergia secondary to spinal cord disease.15 One transperineal injection of botulinum A toxin in the external urethral sphincter was found to be superior to lidocaine injection as evidenced by decreased PVR and maximal urethral pressure - and increased patient satisfaction scores.

Larger randomized controlled trials are needed to determine long-term safety, efficacy, and durability of treatment. Potential side effects include exacerbation of autonomic dysreflexia, infection, urinary incontinence, and allergic reaction. None of these side effects have been reported in the literature to date. Long-term studies after repeated injections are necessary to determine safety, efficacy, and optimal dose in this clinical population.

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How To Have Beutiful Non Aging Skin

Age does a lot of things to us and most of them arent good. Sure, we may get wiser, and more knowledgeable as a result of our experiences over time, but time also takes a hefty toll on our health, and appearance.

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