Parratte B, Bonniaud V, Tatu L, Metton G, Michel F, Cosson A, Monnier G
Service d'explorations et pathologies neuromusculaires, centre hospitalier universitaire Jean-Minjoz, 25030 Besançon cedex, France.
Ann Readapt Med Phys. 2003 Jul;46(6):319-25. doi: 10.1016/s0168-6054(03)00105-3.
Botulinum toxin (BT) injection into the external urethral sphincter is a promising therapy for neurogenic voiding disorders due to detrusor-sphincter dyssynergia (DSD). However the optimal treatment protocol remains unclear.
A PubMed reference search and manual bibliography review were performed, along with a search in the Annales de réadaptation et de médecine physique and in the reports of the International French-language Society of Urodynamics and the International Continence Society, which allowed us to select twelve pertinent articles with PubMed, two articles from the Annales and two conference reports. Our analysis gave special emphasis to assessment criteria, application, dosage and BT injection technique.
Used for the first time in 1988 in spinal cord injury patients to reduce outflow obstruction due to DSD, BT injections have been shown to be a valuable alternative management of bladder dysfunction with DSD. They have been proposed in neurological patients unable to perform self-catheterisation, after drug failure and before surgery. Parameters for results assessment are mostly clinical (increased free interval between voiding, decreased post-void residual urine volumes), urodynamic (improvement in bladder emptying, increase in functional bladder capacity and decrease in urethral pressure) and electromyographic (denervation of striated urethral sphincter). The literature data regarding type of BT, dosage and protocol vary widely. Duration of action is from 2 to 12 months. Both transurethral and transperineal injections monitored by EMG are equally effective in improving detrusor-sphincter dyssynergia.
With few side effects and satisfactory medium-term results, BT should be recommended as a component of DSD therapies. We propose a practical method for BT use.
向尿道外括约肌注射肉毒杆菌毒素（BT）是治疗逼尿肌-括约肌协同失调（DSD）所致神经源性排尿障碍的一种有前景的疗法。然而，最佳治疗方案仍不明确。
进行了PubMed参考文献检索和手工文献综述，同时检索了《康复与物理医学年鉴》以及国际法语尿动力学学会和国际尿失禁学会的报告，这使我们能够从PubMed中筛选出12篇相关文章、从《年鉴》中筛选出2篇文章以及2篇会议报告。我们的分析特别强调了评估标准、应用、剂量和BT注射技术。
1988年首次在脊髓损伤患者中使用BT以减轻因DSD导致的流出道梗阻，BT注射已被证明是治疗DSD所致膀胱功能障碍的一种有价值的替代方法。它们已被推荐用于无法进行自我导尿、药物治疗失败且在手术前的神经科患者。结果评估参数主要是临床参数（排尿间隔时间增加、排尿后残余尿量减少）、尿动力学参数（膀胱排空改善、功能性膀胱容量增加和尿道压力降低）和肌电图参数（横纹肌尿道括约肌失神经支配）。关于BT类型、剂量和方案的文献数据差异很大。作用持续时间为2至12个月。经尿道注射和经会阴注射在肌电图监测下对改善逼尿肌-括约肌协同失调同样有效。
BT副作用少且中期结果令人满意，应推荐作为DSD治疗方法的一部分。我们提出了一种使用BT的实用方法。
