Kidney transplantation and lower tract obstructive uropathy treated by Botox: a case report

The indications for botulinum toxin have been extended in the field of urology, especially in vesicosphincteric dysfunction with good results. The authors report the use of botulinum toxin in a kidney transplant recipient with urethral hypertonia partly responsible for end-stage chronic kidney disease. Mr E.J, 25 years old, was operated for bilateral megaureter with vesicosphincteric dysfunction during childhood. He was managed in our department with serum creatinine of 364 mol/l. Ultrasound showed bilateral ureteropelvic dilatation and residual urine of 300 ml. Urodynamic assessment demonstrated a normally active bladder with normal compliance and urethral hypertonia. An intrasphincter injection of 300 units of Botox was performed in May 2003 with a good result for 11 months. He subsequently received a second intrasphincter injection of 200 units with clinical efficacy maintained for at least six months. This patient underwent living-donor kidney transplantation in May 2005. An intrasphincter injection of 100 units of Botox was performed nine days after transplantation, then every six months. With a follow-up of 16 months, renal function is stable with negligible residual urine. The use of botulinum toxin in non neurogenic urethral hypertonia has been reported in only a few original articles. Botulinum toxin injection into the striated sphincter of the urethra decreases urethral resistance, improving obstructive symptoms and can be effective in kidney transplant recipients.