PD04-12 ONABOTULINUMTOXINA FOR NEUROGENIC DETRUSOR OVERACTIVITY REDUCES FREQUENCY AND SEVERITY OF AUTONOMIC DYSREFLEXIA AND IMPROVES QUALITY OF LIFE FOR INDIVIDUALS WITH SPINAL CORD INJURY

associated increase in voiding pressure.Recurrent sphincter obstruction was seen in 10% (7/73) patients prompting repeat sphincterotomy.Clinical and urodynamic findings suggestive of impaired detrusor contractility was noted in 21% (15/73), 33% (12/36), and 59% (17/29) of patients at 5, 10 and 15 years following initial sphincterotomy.In addition, 41 % (30/73) were on either intermittent catheterization, or had an indwelling catheter.Hydronephrosis was present in 7% (5/73) patients at the time of the initial procedure and resolved after sphincterotomy.No patient developed recurrent hydronephrosis during the follow-up period.CONCLUSIONS: Although voiding pressures and upper tracts remains stable following laser external sphincterotomy, PVR is seen to steadily increase beginning approximately five years following the procedure indicating a trend toward impaired detrusor contractility that accounts for the majority of failures.Patients should be counseled that external sphincterotomy is associated with significant long term failure rates.Further studies are needed to define the natural history of bladder dysfunction in SCI to determine whether this finding of progressive detrusor underactivity occurs in untreated patients who reflexively void.