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

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). This was a randomized, controlled trial conducted over 6 months. Patients with suprasacral SCI and DSD were randomly assigned to two groups. Group 1 received intradetrusor BoNT-A injection with a combination of muscle relaxant and alpha-blocker medication, while Group 2 received concomitant intradetrusor and paraurethral BoNT-A injection. The primary outcome measure was maximum urinary flow rate (Qmax), assessed at baseline and after 6 months of treatment. This study had 35 patients. At baseline, the mean Qmax in Group 1 was 12.6 ml/s, while in Group 2 it was 13.2 ml/s. After 6 months of treatment, the mean Qmax in Group 1 increased to 16.5ml/s, while in Group 2 it increased to 19.8ml/s (P-value<0.05). 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.