Kuo Hann-Chorng
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Urology. 2003 Mar;61(3):550-4. doi: 10.1016/s0090-4295(02)02541-4.
To investigate the effects of botulinum A toxin in treating patients with voiding dysfunction due to detrusor underactivity.
Twenty patients with chronic urinary retention (n = 13) or severe dysuria (n = 7) received 50 U of botulinum A toxin by urethral injection. The clinical effects, obstructive symptom score, quality-of-life index, and urodynamics were compared at baseline and after treatment.
Of the 4 males and 16 females (age range 14 to 86 years) with voiding dysfunction (cauda equina lesion in 5, dysfunctional voiding in 5, peripheral neuropathy in 6, and detrusor failure of unknown origin in 4), 18 (90%) were treated satisfactorily. Among these patients, the mean quality-of-life score decreased significantly from 5.68 +/- 0.67 to 1.16 +/- 1.61. The median voiding pressure (56.5 +/- 41.2 versus 39.0 +/- 38.4 cm H(2)O) decreased significantly, as did the maximal urethral closure pressure (65.5 +/- 38.1 versus 50 +/- 32.1 cm H(2)O) and residual urine volume (300 +/- 189.1 versus 50 +/- 153.6 mL) at 2 weeks after treatment and remained stationary for 3 months. The subjective maximal effect was achieved within 1 to 2 weeks. In 7 patients, the indwelling catheters were removed, and in 4 patients who performed clean intermittent self-catheterization, the frequency decreased or it was discontinued. The other 7 patients with difficult urination had significant improvement in the obstructive symptom score (18 +/- 3.3 versus 7 +/- 4.5, P = 0.000).
Botulinum A toxin at a dose of 50 U was effective in reducing urethral sphincter resistance among our patients with detrusor underactivity and difficult urination.
探讨A型肉毒毒素治疗逼尿肌活动低下所致排尿功能障碍患者的效果。
20例慢性尿潴留患者（13例）或严重排尿困难患者（7例）接受经尿道注射50 U A型肉毒毒素治疗。比较治疗前后的临床效果、梗阻症状评分、生活质量指数及尿动力学指标。
20例排尿功能障碍患者（4例男性，16例女性，年龄14至86岁，其中5例马尾神经损伤，5例功能性排尿障碍，6例周围神经病变，4例不明原因逼尿肌功能衰竭）中，18例（90%）治疗效果满意。这些患者的平均生活质量评分从5.68±0.67显著降至1.16±1.61。治疗2周时，排尿中位压力（56.5±41.2对39.0±38.4 cm H₂O）、最大尿道闭合压（65.5±38.1对50±32.1 cm H₂O）及残余尿量（300±189.1对50±153.6 mL）均显著下降，并在3个月内保持稳定。主观最大疗效在1至2周内实现。7例患者拔除了留置导尿管，4例进行清洁间歇性自家导尿的患者导尿频率降低或停止。另外7例排尿困难患者的梗阻症状评分显著改善（18±3.3对7±4.5，P = 0.000）。
50 U剂量的A型肉毒毒素对降低逼尿肌活动低下及排尿困难患者的尿道括约肌阻力有效。
