External urethral sphincterotomy and Botulinum A toxin intrasphincteric injection for the treatment of Fowler’s syndrome: functional outcomes at 5- years follow-up

Pubblicato da il Mar 18, 2013 in | Commenti disabilitati su External urethral sphincterotomy and Botulinum A toxin intrasphincteric injection for the treatment of Fowler’s syndrome: functional outcomes at 5- years follow-up

==inizio abstract==

Objective
To describe the results, complications and long-term outcomes associated with external sphincterotomy (ES) and intrasphincteric Botulinum A toxin injection (IIBot-A) for the treatment of Fowler’s syndrome (FS) in young women.

Material and Methods
Between 2000-2005 5 female patients affected by FS underwent ES (group A). Since 2005, with the introduction of Botulinum A toxin (BTX-A) in the urological practice, we tested it on 12 cases of FS (group B). Preoperatively all patients were evaluated by voiding cystourethrography, and urodynamic studies. In the group A, ES was provided from the external urethral sphincter to the anterior vaginal wall. In the group B, 200 IU of BotA were injected in the urethral sphincter . We considered a therapeutic failure if any of the following were present postoperatively: symptoms recurrence; presence of large post void residual volumes, high voiding pressures and progressive upper tract deterioration.

Results
In the group A we had one cases of recurrent detrusor sphincter dyssynergy, at 55 months who was successfully retreated with BotA. In the group B the retreatment rate was 32% with a mean time for retreatment of 28 months (range 12-44). The mean follow-up time was 67 months for the group A (range 38-96) and 33 months (range 12-54) for the group B. The larger series in the B group suggests that the number of failures may increase with time. There was no predictor of failure among any of the following parameters: age at operation, preoperative maximum detrusor contraction pressures, or rise time to maximum pressure.

Discussion
Botulinum injection into the urethral sphincter offers interesting features as safety, efficacy, and ease of delivery during long-term repeated usage.

Conclusion
Therapeutic values of BTX-A and ES remain to be confirmed and compared on prospective randomized trials to SNM, which still remains the mainstay of FS treatment.

==fine abstract==