Introduction: Cerebral palsy (CP) is an upper motor neuron disorder that typically results in spasticity of striated muscle, which can include the external urinary sphincter. Symptomatic urinary dysfunction in the form of intermittent retention and flooding may result from tonic spasticity of the external urinary sphincter (pseudodyssynergia). Botulinum toxin (BTX) may be injected to the external urinary sphincter to allow for more facile, regular voiding. In the only study examining the use of sphincter BTX injections, a reduction in chronic catheter dependence and urinary tract infection (UTI) rates in the 15 patients studied was reported. The objective of this study is to evaluate urinary outcomes following cystoscopic external urinary sphincter BTX injections in patients with CP. Methods: In this retrospective cohort study, we reviewed patients with a diagnosis of CP seen in urology clinic from 2016-2022. Patients included were 18 years or older and had undergone a urethral external sphincter BTX injection. Injections were performed with either 100 units or 200 units in 4cc of saline injected to the anterolateral external urethral sphincter. Data was collected via chart review and entered into a REDCap database. Outcomes included: retention, lower urinary tract symptoms (LUTS), hydronephrosis, and recurrent UTIs recorded as better, no change, or worse based on caregiver or patient feedback and repeat imaging. Urodynamics was performed pre-BTX but often not repeated as many patients are unable to void on command so a proper voiding phase could not be captured. Results: 37 patients met inclusion criteria. The median age was 29 years (IQR 25-39), 57% were male, most (54%) lived at home with or without assistance, and 30% resided in a group home. Prior to BTX, most used a combination of a toilet (59%) and diapers (59%) for bladder management. The most common indication for BTX was retention (92%), followed by LUTS (38%), hydronephrosis (24%), and recurrent UTIs (22%). Post-BTX subjective improvement was seen in 71% (24/34) of patients with retention, 79% (11/14) with LUTS, 75% (6/8) with recurrent UTIs, and 78% (7/9) with hydronephrosis. The majority (68%) of patients underwent repeat injections, typically every 3-6 months. There were no significant complications associated with injections. Conclusions: External urethral sphincter BTX is a safe, effective option for treating urinary dysfunction in adults with CP. SOURCE OF Funding: None.
