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    Interventional procedure overview of botulinum toxin type A injection into the urethral sphincter for idiopathic chronic non-obstructive urinary retention

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    Description of the procedure

    Indications and current treatment

    Idiopathic non-obstructive urinary retention is the inability to completely empty the bladder with no physical obstruction (in the urethra or bladder neck) to normal urine flow. It can be caused by USD. This can be because of DV, urethral sphincter hyperactivity or inadequate relaxation of the urethral sphincter (for example, Fowler's syndrome in younger women), or bladder functional problems (detrusor muscle underactivity, or detrusor hyperreflexia and inadequate contractility). But the specific underlying cause of the condition is unknown. Idiopathic non-obstructive urinary retention is often asymptomatic, but some people have lower abdominal discomfort and pain. Also, it can cause complications such as recurrent UTIs and chronic kidney disease.

    Current treatments for non-obstructive urinary retention include urotherapy (that is, education and rehabilitation for bladder and bowel management), an alpha adrenoreceptor-blocker medicine, urethral dilatation or CIC. When the condition is refractory to these treatments, it may be treated with sacral nerve stimulation or urinary diversion procedures.

    What the procedure involves

    Botulinum toxin type A injection into the urethral sphincter for idiopathic chronic non-obstructive urinary retention is usually done under EMG, or electrical stimulation and cystoscopy guidance. It is usually done with the person awake and lying in the lithotomy position. A local anaesthetic may be used. Botulinum toxin type A diluted with normal saline is injected directly into the external urethral sphincter using a syringe needle. A transperineal route is used in women and a transurethral route is used in men.

    The dose and number of injections, and the depth and position of injections on the EUS, vary and depend on the discretion of the clinician. After the treatment, an overnight catheter is inserted for drainage. People are discharged from hospital the next day and have oral antibiotics for a week. The aim of the procedure is to relax the sphincter muscle and restore voiding function. It may be repeated every few months.