{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T08:26:03Z","timestamp":1775550363603,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T00:00:00Z","timestamp":1566518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Botulinum toxin A (BoNT-A) urethral sphincter injections have been applied in treating voiding dysfunction but the treatment outcome is not consistent. This study analyzed treatment outcomes between patients with different bladder and urethral sphincter dysfunctions. Patients with refractory voiding dysfunction due to neurogenic or non-neurogenic etiology were treated with urethral sphincter 100 U BoNT-A injections. The treatment outcomes were assessed by a global response assessment one month after treatment. The bladder neck opening and urodynamic parameters in preoperative videourodynamic study were compared between successful and failed treatment groups. A total of 80 non-neurogenic and 75 neurogenic patients were included. A successful outcome was noted in 92 (59.4%) patients and a failed outcome in 63 (40.6%). The treatment outcome was not affected by the gender, voiding dysfunction subtype, bladder dysfunction, or sphincter dysfunction subtypes. Except an open bladder neck and higher maximum flow rate, no significant difference was noted in the other variables between groups. Non-neurogenic patients with successful outcomes had a significantly higher detrusor pressure, and patients with neurogenic voiding dysfunction with successful results had higher maximum flow rates and smaller post-void residuals than those who failed the treatment. However, increased urinary incontinence was reported in 12 (13%) patients. BoNT-A urethral sphincter injection is effective in about 60% of either neurogenic or non-neurogenic patients with voiding dysfunction. An open bladder neck during voiding and a higher maximum flow rate indicate a successful treatment outcome.<\/jats:p>","DOI":"10.3390\/toxins11090487","type":"journal-article","created":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T04:38:23Z","timestamp":1566794303000},"page":"487","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Therapeutic Effects of Botulinum Toxin A, via Urethral Sphincter Injection on Voiding Dysfunction Due to Different Bladder and Urethral Sphincter Dysfunctions"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9325-9868","authenticated-orcid":false,"given":"Yu-Khun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7165-4771","authenticated-orcid":false,"given":"Hann-Chorng","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Jiang, Y.H., and Kuo, H.C. (2017). Video-urodynamic characteristics of non-neurogenic, idiopathic underactive bladder in men\u2014A comparison of men with normal tracing and bladder outlet obstruction. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174593"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Yang, T.H., Chuang, F.C., and Kuo, H.C. (2018). Urodynamic characteristics of detrusor underactivity in women with voiding dysfunction. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198764"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6845","DOI":"10.1038\/s41598-017-07163-2","article-title":"Videourodynamic Studies of Women with Voiding Dysfunction","volume":"7","author":"Hsiao","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_4","first-page":"24","article-title":"Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: A double-blind study","volume":"71","author":"Dykstra","year":"1990","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S0022-5347(01)66376-6","article-title":"Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: A prospective study in 24 spinal cord injury patients","volume":"155","author":"Schurch","year":"1996","journal-title":"J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/S0140-6736(05)79580-5","article-title":"Relief by botulinum toxin of voiding dysfunction due to prostatitis","volume":"352","author":"Maria","year":"1998","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/S0022-5347(05)66438-5","article-title":"Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction","volume":"165","author":"Phelan","year":"2001","journal-title":"J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1097\/01.ju.0000091281.50081.f0","article-title":"Botulinum A toxin urethral injection for the treatment of lower urinary tract dysfunction","volume":"170","author":"Kuo","year":"2003","journal-title":"J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.eururo.2013.10.033","article-title":"An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders","volume":"65","author":"Mangera","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/j.juro.2006.03.119","article-title":"Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder","volume":"176","author":"Mokhless","year":"2006","journal-title":"J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1016\/j.juro.2007.03.185","article-title":"The use of botulinum toxin A injection for the management of external sphincter dyssynergia in neurologically normal children","volume":"178","author":"Franco","year":"2007","journal-title":"J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"38905","DOI":"10.1038\/srep38905","article-title":"OnabotulinumtoxinA Urethral Sphincter Injection as Treatment for Non-neurogenic Voiding Dysfunction\u2014A Randomized, Double-Blind, Placebo-Controlled Study","volume":"6","author":"Jiang","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/bju.13342","article-title":"Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation (Fowler\u2019s syndrome)","volume":"117","author":"Panicker","year":"2016","journal-title":"BJU Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/luts.12195","article-title":"Videourodynamic factors predictive of successful onabotulinumtoxinA urethral sphincter injection for neurogenic or non-neurogenic detrusor underactivity","volume":"11","author":"Jiang","year":"2019","journal-title":"Low Urin. Tract. Symptoms"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1097\/01.ju.0000127725.48479.89","article-title":"Emerging role of botulinum toxin in the treatment of voiding dysfunction","volume":"171","author":"Smith","year":"2004","journal-title":"J. Urol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S0302-2838(02)00209-9","article-title":"Botulinum a toxin and detrusor sphincter dyssynergia: A double-blind lidocaine-controlled study in 13 patients with spinal cord disease","volume":"42","author":"Petit","year":"2002","journal-title":"Eur. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.apmr.2011.11.020","article-title":"A meta-analysis of botulinum toxin sphincteric injections in the treatment of incomplete voiding after spinal cord injury","volume":"93","author":"Mehta","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.urology.2004.08.016","article-title":"Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra","volume":"65","author":"Smith","year":"2005","journal-title":"Urology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1159\/000079697","article-title":"Botulinum A toxin treatment of urethral sphincter pseudodyssynergia in patients with cerebrovascular accidents or intracranial lesions","volume":"73","author":"Chen","year":"2004","journal-title":"Urol. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/S0302-2838(03)00250-1","article-title":"Botulinum toxin as a new therapy option for voiding disorders: Current state of the art","volume":"44","author":"Leippold","year":"2003","journal-title":"Eur. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/S0090-4295(02)02541-4","article-title":"Effect of botulinum a toxin in the treatment of voiding dysfunction due to detrusor underactivity","volume":"61","author":"Kuo","year":"2003","journal-title":"Urology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.urology.2006.08.1117","article-title":"Recovery of detrusor function after urethral botulinum A toxin injection in patients with idiopathic low detrusor contractility and voiding dysfunction","volume":"69","author":"Kuo","year":"2007","journal-title":"Urology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/nau.20606","article-title":"Satisfaction with urethral injection of botulinum toxin A for detrusor sphincter dyssynergia in patients with spinal cord lesion","volume":"27","author":"Kuo","year":"2008","journal-title":"Neurourol. Urodyn."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1136\/jnnp.2004.045765","article-title":"Placebo-controlled, randomised, double-blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients","volume":"76","author":"Gallien","year":"2005","journal-title":"J. Neurol. Neurosurg Psychiatry"},{"key":"ref_25","first-page":"5787","article-title":"Injection of botulinum toxin type A in the urethral sphincter to treat lower urinary tract dysfunction: Review of indications, techniques and results: 2011 update","volume":"18","author":"Mahfouz","year":"2011","journal-title":"Can J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/S0022-5347(17)42717-0","article-title":"Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients","volume":"139","author":"Dykstra","year":"1988","journal-title":"J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.urology.2007.06.1083","article-title":"Causes of failed urethral botulinum toxin A treatment for emptying failure","volume":"70","author":"Liao","year":"2007","journal-title":"Urology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jfma.2012.04.008","article-title":"Clinical and video urodynamic characteristics of adult women with dysfunctional voiding","volume":"113","author":"Chen","year":"2014","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/B978-0-12-801772-2.00038-2","article-title":"Urologic symptoms and functional neurologic disorders","volume":"139","author":"Hoeritzauer","year":"2016","journal-title":"Handb. Clin. Neurol."},{"key":"ref_30","first-page":"187","article-title":"Current pharmacological and surgical treatment of underactive bladder","volume":"29","author":"Jiang","year":"2017","journal-title":"Investig. Clin. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.juro.2016.07.071","article-title":"Urothelial Barrier Deficits, Suburothelial Inflammation and Altered Sensory Protein Expression in Detrusor Underactivity","volume":"197","author":"Jiang","year":"2017","journal-title":"J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1111\/ijcp.12152","article-title":"Therapeutic outcome and quality of life between urethral and detrusor botulinum toxin treatment for patients with spinal cord lesions and detrusor sphincter dyssynergia","volume":"67","author":"Kuo","year":"2013","journal-title":"Int. J. Clin. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/nau.10052","article-title":"The standardisation of terminology of lower urinary tract function: Report from the standardisation sub\u2013committee of the international continence society","volume":"21","author":"Abrams","year":"2002","journal-title":"Neurourol. Urodyn."}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/9\/487\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:13:35Z","timestamp":1760188415000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/11\/9\/487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,23]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["toxins11090487"],"URL":"https:\/\/doi.org\/10.3390\/toxins11090487","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,23]]}}}