Smith Christopher P, Radziszewski Piotr, Borkowski Andrzej, Somogyi George T, Boone Timothy B, Chancellor Michael B
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
Urology. 2004 Nov;64(5):871-5; discussion 875. doi: 10.1016/j.urology.2004.06.073.
To present clinical evidence with botulinum toxin A (BTX-A) suggesting an antinociceptive role in patients with interstitial cystitis (IC). Intriguing evidence in a somatic pain model has suggested that BTX-A injection may have an antinociceptive effect on both acute and chronic (inflammatory) pain.
Thirteen female patients (6 in the United States and 7 in Poland) with IC according to the criteria of the National Institute of Diabetes, Digestive and Kidney Disease were included. Under short general anesthesia or sedation, 100 to 200 U of Dysport (Polish patients) or Botox (U.S. patients) was injected through a cystoscope into 20 to 30 sites submucosally in the trigone and floor of the bladder. Patients were evaluated with the O'Leary-Sant validated IC questionnaire or with voiding charts and a visual analog pain scale 1 month postoperatively and at subsequent 3-month intervals. The Polish patients also underwent pretreatment and post-treatment urodynamic evaluations.
Overall, 9 (69%) of 13 patients noted subjective improvement after BTX-A treatment. The Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index mean scores improved by 71% and 69%, respectively (P <0.05). Daytime frequency, nocturia, and pain by visual analog scale decreased by 44%, 45%, and 79%, respectively (P <0.01). The first desire to void and maximal cystometric capacity increased by 58% and 57%, respectively (P <0.01).
Our results suggest that BTX-A has an antinociceptive effect on bladder afferent pathways in patients with IC, producing both symptomatic and functional (ie, urodynamic) improvements.
提供关于A型肉毒毒素（BTX-A）在间质性膀胱炎（IC）患者中具有抗伤害感受作用的临床证据。在躯体疼痛模型中的有趣证据表明，BTX-A注射可能对急性和慢性（炎症性）疼痛均具有抗伤害感受作用。
纳入13名符合美国国立糖尿病、消化和肾脏疾病研究所标准的IC女性患者（美国6例，波兰7例）。在短暂全身麻醉或镇静下，通过膀胱镜将100至200单位的Dysport（波兰患者）或保妥适（美国患者）黏膜下注射到膀胱三角区和底部的20至30个部位。术后1个月及随后每隔3个月，使用经O'Leary-Sant验证的IC问卷、排尿图表和视觉模拟疼痛量表对患者进行评估。波兰患者还接受了治疗前和治疗后的尿动力学评估。
总体而言，13名患者中有9名（69%）在BTX-A治疗后主观症状有所改善。间质性膀胱炎症状指数和间质性膀胱炎问题指数的平均得分分别提高了71%和69%（P<0.05）。日间排尿频率、夜尿症以及视觉模拟量表评估的疼痛分别降低了44%、45%和79%（P<0.01）。首次排尿欲望和最大膀胱测压容量分别增加了58%和57%（P<0.01）。
我们的结果表明，BTX-A对IC患者的膀胱传入通路具有抗伤害感受作用，可产生症状和功能（即尿动力学）方面的改善。
