Hindley R G, Brierly R D, Thomas P J
Department of Urology, Royal Sussex County Hospital, Brighton, East Sussex, UK.
BJU Int. 2004 Jan;93(1):89-92. doi: 10.1111/j.1464-410x.2004.04563.x.
To test the hypothesis, in a prospective randomized double-blind study, that the combination of intravesical prostaglandin E2 (PGE2) and oral bethanechol chloride (BC) are additive or synergistic in improving bladder emptying, as they have been used alone for treating impaired detrusor contractility with little clinical benefit.
Nineteen patients with detrusor underactivity (17 men and two women) were eligible and randomized to one of two treatments. All had postvoid residual urine volumes (PVR) consistently of > 300 mL, most being reliant on clean intermittent self-catheterization (CISC). The experimental treatment group (nine patients) received once-weekly intravesical PGE2 (1.5 mg in 20 mL 0.9% saline) plus BC 50 mg four times daily, for a total of 6 weeks. The second group of 10 patients received a once-weekly instillation of saline together with placebo tablets, again for 6 weeks.
Before treatment the median (interquartile range) PVR was 426 (405-480) mL for those receiving both drugs; this decreased to 325 (290-352) mL after completing the treatment (P < 0.015). In the placebo group the respective values were 576 (539-777) and 538 (350-775) mL (P = 0.09). Four of the patients receiving the active combination reported symptomatic improvement and were able to reduce the frequency of CISC.
Although there was evidence of a pharmacological effect, BC and PGE2 had a limited therapeutic effect compared with placebo. Whilst we would not recommend this treatment as routine, it may be considered for the occasional treatment of a patient with detrusor underactivity.
在一项前瞻性随机双盲研究中检验以下假设：膀胱内前列腺素E2（PGE2）与口服氯贝胆碱（BC）联合使用在改善膀胱排空方面具有相加或协同作用，因为它们单独使用时治疗逼尿肌收缩功能受损的临床益处不大。
19例逼尿肌活动低下患者（17例男性，2例女性）符合条件并随机分为两种治疗方法之一。所有患者排尿后残余尿量（PVR）均持续大于300 mL，大多数患者依赖清洁间歇性自家导尿（CISC）。实验治疗组（9例患者）每周接受一次膀胱内注射PGE2（1.5 mg溶于20 mL 0.9%盐水中）加BC 50 mg，每日4次，共6周。第二组10例患者每周接受一次盐水灌注加安慰剂片，同样持续6周。
接受两种药物治疗的患者治疗前PVR中位数（四分位间距）为426（405 - 480）mL；治疗结束后降至325（290 - 352）mL（P < 0.015）。安慰剂组的相应数值分别为576（539 - 777）和538（350 - 775）mL（P = 0.09）。接受活性联合治疗的患者中有4例报告症状改善，且能够减少CISC的频率。
虽然有证据表明存在药理作用，但与安慰剂相比，BC和PGE2的治疗效果有限。虽然我们不建议将这种治疗作为常规方法，但对于偶尔治疗逼尿肌活动低下的患者可以考虑。
