Chen et al. 2008; Taiwan
Downs & Black = 21
Pre-Post
N = 20
(with AD=4)

Population: 20 suprasacral SCI subjects with detrusor external sphincter dyssynergia (DESD); Mean age 37.9 (15.7); 17 male; 12 cervical, 3 thoracic, 5 lumbar; AIS diagnosis: 11 AIS-A, 2 AIS-B, 4 AIS-C, 3 AIS-D.
Treatment: A single dose of 100 IU was applied
into the external urethral sphincter via cystoscopy
Outcome Measures: maximal detrusor pressure, maximal urethral pressure, maximal detrusor leak point pressure, integrated electromyography (IEMG) of the external urethral sphincter and, maximal pressure on static urethral pressure profilometry, recorded before and 4 weeks after the injection; post-voiding residues, measured 1, 2, 3, and 6 months post-injection

1. 4 patients who had AD symptoms before treatment reported decreased frequency and intensity of AD
2. There was significant reduction in the IEMG (from 16.7+13.6 to 12.5+12.9 uV), as well as static urethral pressure (from 139.4+40.5 to 104.8+30.5) and maximal urethral pressure (from 107.5+69.1 to 80.2+35.7 cmH2O)
3. There was no significant difference in the maximal detrusor pressure or detrusor leak point pressure
4. Post-voiding residues were significantly reduced at 1st, 2nd, 3rd, and 6th months post-injection

Kuo 2008; Taiwan
Downs & Black = 18
Pre-Post
N = 33
(with AD=6)

Population: 33 subjects suffering from detrusor sphincter dyssynergia and urinary incontinence (including 9 individuals with cervical SCI, 12 with thoracic SCI, 5 with lumbar SCI, 5 multiple sclerosis and 2 transverse myelitis patients); age range 23-71
Treatment: transurethral sphincter botox injections, injecting 100 units of botox in 4 ml normal saline into eight sites of the urethral sphincter
Outcome Measures: videourodynamic studies; Urogenital Distress Inventory short form (UDI-6); Incontinence Impact Questionnaire (IIQ-7) short form

1. 3/6 patients experienced decreased symptoms of AD post-treatment.
2. Urodynamic parameters showed significant improvement in voiding detrusor pressure (45.7+22.7 vs. 30.7+15.5 cmH2O), maximum flow rate (6.8+5.7 vs. 9.2+7.7 ml/sec) and postvoid residual volume (160+124 vs. 75+105 ml)
3. IIQ-7 scores were significantly improved, but not the UDI-6 scores

Dykstra et al. 1988; USA
Downs & Black = 12
Pre-post
N=11 (with AD=7)

Population: Detrusor-sphincter dyssynergia
Treatment: low dose botulinum A toxin at the neuromuscular junction
Outcome Measures: urethral pressure, symptoms of AD

1. Urethral pressure profile decreased 27 cm H20 (n=7)
2. Self-assessed improvement of AD symptoms in 5 of 7 AD patients
3. Toxin effects lasted an average of 50 days.

Schurch et al. 2000; Switzerland
Downs & Black =11
Pre-post
N initial = 31
N final = 19

Population: Mean age: 36.7 years, TSI=60.218  subjects with paraplegia, 3 with tetraplegia, 17 subjects with complete injuries, 4 with incomplete injuries, incontinence resistant to anticholinergic medication
Treatment: Botulinum-A toxin was injected (200-300 units) into the detrusor muscle. 
Outcome Measures: voiding and detrusor pressure, diary of incontinence, AD symptoms at 6, 16, and 36-wks.

1. At 6-week follow-up 17/19 patients were completely continent.
2. 3 patients with tetraplegia with severe AD with bladder emptying found this disappeared after treatment.