{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:42:27Z","timestamp":1792147347249,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,11,8]],"date-time":"2015-11-08T00:00:00Z","timestamp":1446940800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Department of Health a National Institute for Health Research"},{"name":"The Urology Foundation and the InComb project"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2016,5]]},"abstract":"\n Objectives<\/jats:title>\n \n To assess the efficacy (defined as improvements in maximum urinary flow rate [\n Q<\/jats:italic>\n max<\/jats:sub>\n ] of \u226550%, post\u2010void residual urine volume [\n PVR<\/jats:styled-content>\n ] and scores on the International Prostate Symptom Score [\n IPSS<\/jats:styled-content>\n ] questionnaire) and safety of urethral sphincter injections of onabotulinumtoxinA in women with a primary disorder of urethral sphincter relaxation, characterised by an elevated urethral pressure profile (\n UPP<\/jats:styled-content>\n ) and specific findings at urethral sphincter electromyography (\n EMG<\/jats:styled-content>\n ), i.e. Fowler's syndrome.\n <\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n \n In this open\u2010label pilot Institutional Review Board\u2010approved study, 10 women with a primary disorder of urethral sphincter relaxation (elevated\n UPP<\/jats:styled-content>\n , sphincter volume, and abnormal\n EMG<\/jats:styled-content>\n ) presenting with obstructed voiding (five) or in complete urinary retention (five) were recruited from a single tertiary referral centre. Baseline symptoms were assessed using the\n IPSS<\/jats:styled-content>\n , and\n Q<\/jats:italic>\n max<\/jats:sub>\n and\n PVR<\/jats:styled-content>\n were measured. After 2% lidocaine injection, 100 U of onabotulinumtoxinA was injected into the striated urethral sphincter, divided on either side, under\n EMG<\/jats:styled-content>\n guidance. Patients were reviewed at 1, 4 and 10 weeks after injection, and assessed using the\n IPSS<\/jats:styled-content>\n ,\n Q<\/jats:italic>\n max<\/jats:sub>\n and\n PVR<\/jats:styled-content>\n measurements. The\n UPP<\/jats:styled-content>\n was repeated at week 4.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean (range) patient age was 40 (25\u201365) years, and the mean symptom scores on the\n IPSS<\/jats:styled-content>\n improved from 25.6 to 14.1, and the mean \u2018bother\u2019 score reduced from 6.1 to 3.5 at week 10. As compared with a baseline mean\n Q<\/jats:italic>\n max<\/jats:sub>\n of 8.12 mL\/s in the women who could void, the\n Q<\/jats:italic>\n max<\/jats:sub>\n improved to 15.8 mL\/s at week 10. Four of the five women in complete retention could void spontaneously, with a mean\n Q<\/jats:italic>\n max<\/jats:sub>\n of 14.3 mL\/s at week 10. The mean\n PVR<\/jats:styled-content>\n decreased from 260 to 89 mL and the mean static\n UPP<\/jats:styled-content>\n improved from 113 cmH\n 2<\/jats:sub>\n O at baseline to 90 cmH\n 2<\/jats:sub>\n O. No serious side\u2010effects were reported. Three women with a history of recurrent urinary tract infections developed a urinary tract infection. There were no reports of stress urinary incontinence. Seven of the 10 women opted to return for repeat injections.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n This pilot study shows an improvement in patient\u2010reported lower urinary tract symptoms, and the objective parameters of\n Q<\/jats:italic>\n max<\/jats:sub>\n ,\n PVR<\/jats:styled-content>\n and\n UPP<\/jats:styled-content>\n , at 10 weeks after urethral sphincter injections of onabotulinumtoxinA. No serious side\u2010effects were reported. This treatment could represent a safe outpatient treatment for young women in retention due to a primary disorder of urethral sphincter relaxation. However, a larger study is required to confirm the findings of this pilot study.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/bju.13342","type":"journal-article","created":{"date-parts":[[2015,10,5]],"date-time":"2015-10-05T07:20:46Z","timestamp":1444029646000},"page":"809-813","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Open\u2010label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler's syndrome)"],"prefix":"10.1111","volume":"117","author":[{"given":"Jalesh N.","family":"Panicker","sequence":"first","affiliation":[{"name":"Department of Uro\u2010Neurology The National Hospital for Neurology and Neurosurgery University College London (UCL) Institute of Neurology London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jai H.","family":"Seth","sequence":"additional","affiliation":[{"name":"Department of Uro\u2010Neurology The National Hospital for Neurology and Neurosurgery University College London (UCL) Institute of Neurology London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahid","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Uro\u2010Neurology The National Hospital for Neurology and Neurosurgery University College London (UCL) Institute of Neurology London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwen","family":"Gonzales","sequence":"additional","affiliation":[{"name":"Department of Uro\u2010Neurology The National Hospital for Neurology and Neurosurgery University College London (UCL) Institute of Neurology London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collette","family":"Haslam","sequence":"additional","affiliation":[{"name":"Department of Uro\u2010Neurology The National Hospital for Neurology and Neurosurgery University College London (UCL) Institute of Neurology London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas M.","family":"Kessler","sequence":"additional","affiliation":[{"name":"Neuro\u2010Urology Spinal Cord Injury Centre Balgrist University Hospital University of Z\u00fcrich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare J.","family":"Fowler","sequence":"additional","affiliation":[{"name":"Department of Uro\u2010Neurology The National Hospital for Neurology and Neurosurgery University College London (UCL) Institute of Neurology London 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