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Botulinum toxin A versus electrogalvanic stimulation for levator ani syndrome: is one a more effective therapy?

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Abstract

Background

Levator ani syndrome (LAS) is a functional disorder that can be a challenge to treat. LAS that is refractory to medical management may be treated with electrogalvanic stimulation (EGS) or Botulinum toxin A (BTX) injection. The aim of the present study was to evaluate the outcomes associated with both EGS and BTX in patients with medically refectory LAS to determine if either demonstrate a long-term benefit or whether one treatment is better than the other.

Methods

A retrospective study was performed on consecutive patients with LAS treated with BTX or EGS at our institute. Patients were identified from a prospectively maintained database. The study time frame was 6 years.

Results

One hundred and twenty patients [80 females, mean age 52 years (range 21–84, SD 15.8)] were treated for medically refractory LAS: 102 with BTX and 18 with EGS. With EGS, 28.6% of patients reported a complete response, 14.3% reported a partial response and 57.1% reported no response to treatment. With BTX, 35.5% of patients reported a complete response, 19.7% reported a partial response and 44.7% reported no response to treatment. There was no difference between BTX and EGS with regard to treatment response. Patients who had BTX were more likely to report a short-term benefit in treatment when compared to those patients who had EGS (p = 0.002). This difference between reported outcome to BTX and EGS treatments did not sustain in the long term (p = 0.2).

Conclusions

Both BTX and EGS are to some extent effective at resolving symptoms of LAS. In the short term, BTX appears to be more effective. Neither treatment sustains its benefit in the long term.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    E. Nugent, M. Beal, G. Sun & M. Zutshi

Authors
  1. E. Nugent
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  2. M. Beal
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  3. G. Sun
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  4. M. Zutshi
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Contributions

EN: design, data collection, data analysis, manuscript writing. MB: data collection, data analysis, manuscript writing. SG: data collection, data analysis, manuscript writing. MZ: design, data analysis, manuscript editing.

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Correspondence to E. Nugent.

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All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Nugent, E., Beal, M., Sun, G. et al. Botulinum toxin A versus electrogalvanic stimulation for levator ani syndrome: is one a more effective therapy?. Tech Coloproctol 24, 545–551 (2020). https://doi.org/10.1007/s10151-019-02103-w

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  • DOI: https://doi.org/10.1007/s10151-019-02103-w

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