SUFU 2018: Onabotulinum Toxin Injection to Treat DESD In Patients with Cerebral Palsy
The author identified patients treated at University of Wisconsin Hospital and Clinics between Jan 1, 2006 and Jan 1, 2017 with infantile cerebral palsy (ICD-9 343, ICD-10 G80) and onabotulinum injection of the external sphincter (CPT 52287). Severity of CP was assessed based on wheelchair dependence, ability to communicate and institutionalization. Presenting symptoms, urodynamic findings, and treatment were extracted from chart review. Patient/caregiver report of symptoms and post-void residuals were recorded during follo-up. All patients were treated with 100 units of onabotulinum injected in four quadrants of the external sphincter with local anesthesia. Injections were repeated at intervals of 6 months to 1 year.
Seven patients, 5 males and 2 females, with CP and DESD were treated during the study period. Six (87%) were institutionalized, non-verbal, and completely dependent on caregivers. The median age was 34 years old (range 24-79 years old). Median length of follow-up was 1.9 years (range 0.3-8.0 years). Four patients (57%) presented with incomplete emptying and, of these, three had had indwelling catheters. Four patients presented with recurrent UTI. All patients had evidence of detrusor overactivity and DESD during voiding. After onabotulinum injection, no patient required indwelling or intermittent catheterization. The three patients with indwelling catheters were able to void spontaneously. Patients with recurrent UTI reported a reduction in frequency of UTI. Two patients (29%) presenting with bilateral hydronephrosis exhibited improvement or resolution on follow-up ultrasound.
In conclusion the authors found that onabotulinum injection to the external sphincter is an effective intervention to relieve catheter dependence, decrease frequency of UTI and protect the upper tract in patients with CP and DESD.
Presented by: Ruthie Su MD, Madison, WI
Co Author: Wade Bushman, MD PhD, Madison, WI
Written by: Bilal Farhan, MD, Female Urology Fellow and Voiding Dysfunction, Department of Urology, University of California, Irvine at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas