Kuo Hann-chorng
Department of Urology, Buddhist Tzu Chi General Hospital, 707, Section 3 Chung Yang Road, Hualien, Taiwan.
J Urol. 2003 Sep;170(3):835-9. doi: 10.1097/01.ju.0000081652.31524.27.
Evidence suggests that unmyelinated C fibers become predominant in the mediation of the detrusor reflex in patients with chronic spinal cord lesions and possibly in idiopathic detrusor hyperactivity. Intravesical vanilloid therapy might be effective in treating refractory detrusor overactivity due to nonspinal cord lesion. This study investigated the clinical effect of intravesical resiniferatoxin in treating detrusor overactivity of nonspinal cord lesions refractory to anticholinergics.
A total of 41 patients received intravesical resiniferatoxin therapy with 10 ml of 100 nM resiniferatoxin in 10% ethanol solution for 40 minutes. The clinical effects on a decrease in incontinence episodes and urodynamic study were evaluated at baseline and after treatment. Clinical improvement was considered if patients became dry or had a decrease in incontinence episodes of 50%. Therapeutic results were analyzed by disease category and type of initial detrusor response.
Of the 41 patients 10 had neurogenic lesions, 18 had previous transurethral prostatectomy and 13 had idiopathic detrusor overactivity. There were 20 women and 21 men with a mean age of 73.6 years (range 43 to 82) and a symptom duration of 3.6 +/- 4.5 years. After resiniferatoxin treatment 21 patients had clinical improvement (51.2%) including 5 with neurogenic (50%), 11 with previous transurethral prostatectomy (61.1%) and 5 with idiopathic detrusor overactivity (38.5%). An improvement was found in 11 patients with type I initial response (84.6%), 3 patients with type II response (23%) and 7 patients with type III response (46.7%). The 21 patients with improvement had a significant increase in cystometric capacity (208 +/- 80.7 vs 287.2 +/- 118.6 ml, p = 0.001) and a significant decrease in detrusor pressure (33.6 +/- 11.1 vs 27.4 +/- 11.8 cmH(2)O, p = 0.047), but no significant difference in maximal flow rate and residual urine volume.
Intravesical resiniferatoxin was effective in treating refractory detrusor overactivity in 51.2% of patients with nonspinal cord lesions. Patients with detrusor overactivity due to previous bladder outlet obstruction benefited the most. Detrusor contractility decreased after resiniferatoxin treatment in the group with improvement but did not influence voiding efficiency. The initial detrusor response to resiniferatoxin treatment might predict the clinical outcome.
有证据表明，在慢性脊髓损伤患者以及可能在特发性逼尿肌活动亢进患者中，无髓鞘C纤维在逼尿肌反射的介导中占主导地位。膀胱内给予香草酸类药物治疗可能对治疗非脊髓损伤所致的难治性逼尿肌过度活动有效。本研究调查了膀胱内给予树脂毒素治疗抗胆碱能药物难治性非脊髓损伤性逼尿肌过度活动的临床效果。
共有41例患者接受膀胱内树脂毒素治疗，将10 ml 100 nM树脂毒素溶于10%乙醇溶液中，灌注40分钟。在基线期和治疗后评估对尿失禁发作减少的临床效果以及尿动力学研究结果。如果患者变得干爽或尿失禁发作减少50%，则认为临床有改善。根据疾病类别和初始逼尿肌反应类型分析治疗结果。
41例患者中，10例有神经源性病变，18例曾接受经尿道前列腺切除术，13例有特发性逼尿肌过度活动。有20名女性和21名男性，平均年龄73.6岁（范围43至82岁），症状持续时间为3.6±4.5年。树脂毒素治疗后，21例患者有临床改善（51.2%），包括5例神经源性病变患者（50%）、11例曾接受经尿道前列腺切除术患者（61.1%）和5例特发性逼尿肌过度活动患者（38.5%）。11例I型初始反应患者中有改善（84.6%），3例II型反应患者中有改善（23%），7例III型反应患者中有改善（46.7%）。21例有改善的患者膀胱测压容量显著增加（208±80.7 vs 287.2±118.6 ml，p = 0.001），逼尿肌压力显著降低（33.6±11.1 vs 27.4±11.8 cmH₂O，p = 0.047），但最大尿流率和残余尿量无显著差异。
膀胱内给予树脂毒素对51.2%的非脊髓损伤患者的难治性逼尿肌过度活动有效。既往有膀胱出口梗阻所致逼尿肌过度活动的患者获益最大。在有改善的组中，树脂毒素治疗后逼尿肌收缩力下降，但不影响排尿效率。树脂毒素治疗的初始逼尿肌反应可能预测临床结果。
