Popat Roshni, Apostolidis Apostolos, Kalsi Vinay, Gonzales Gwendoline, Fowler Clare J, Dasgupta Prokar
Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, United Kingdom.
J Urol. 2005 Sep;174(3):984-9. doi: 10.1097/01.ju.0000169480.43557.31.
Several studies have shown that intradetrusor injections of botulinum neurotoxin type A (BoNT/A) may effectively treat intractable spinal neurogenic detrusor overactivity (NDO), but fewer reports exist on the use of BoNT/A in patients with idiopathic detrusor overactivity (IDO). The purpose of this study was to investigate whether comparable efficacy could be displayed in the response of patients with IDO to those with NDO.
In a prospective, open label study, patients with urgency, and/or urgency incontinence due to urodynamically proven intractable detrusor overactivity received 300 units (NDO) or 200 units (IDO) of Botox injected into the bladder with a minimally invasive outpatient technique. Urodynamic maximum cystometric capacity and maximum detrusor pressure during filling, frequency of voids (frequency), number of incontinence episodes (leak) and number of voids associated with urgency per 24 hours (urgency) from 4-day voiding diaries were compared between the 2 groups at baseline and for changes at 4 and 16 weeks after treatment.
A total of 44 patients with spinal NDO and 31 with IDO were treated. At 16 weeks, mean +/- standard error maximum cystometric capacity increased from 229.1 +/- 24.8 to 427.0 +/- 26.9 ml, p <0.0001 in NDO and from 193.6 +/- 24.0 to 327.1 +/- 36.1 ml, p=0.0008 in IDO. Maximum detrusor pressure during filling decreased from 60.7 +/- 6.8 to 26.1 +/- 3.7 cm H2O, p <0.0001 in NDO and from 62.1 +/- 10.8 to 45.1 +/- 8.1 cm H2O, p=0.027 in IDO. Frequency decreased from 12.3 +/- 0.7 to 6.6 +/- 0.6 voids per 24 hours, p <0.0001 in NDO and from 13.6 +/- 1.1 to 8.3 +/- 0.7, p=0.0002 in IDO. Leak decreased from 3.9 +/- 0.5 to 0.7 +/- 0.2 incontinence episodes per 24 hours, p <0.0001 in NDO and from 3.2 +/- 0.8 to 0.6 +/- 0.3, p=0.0017 in IDO, and urgency decreased from 7.5 +/- 0.6 to 1.44 +/- 0.3 episodes per 24 hours, p <0.0001 in NDO and from 10.9 +/- 1.7 to 4.9 +/- 1.1, p <0.0001 in IDO. The 2 groups were comparable for baseline data, but percent improvement in urgency was greater in patients with NDO at 4 weeks (78.2% vs 56.3%, p=0.019) and 16 weeks (78.3% vs 50.7%, p=0.013). Of patients with NDO 69% required self-catheterization de novo posttreatment compared with 19.3% of those with IDO.
Patients with intractable IDO respond to intradetrusor BoNT/A with equally significant improvements in urodynamic and lower urinary tract symptom parameters as those with spinal NDO, despite the lower dose of toxin used.
多项研究表明，膀胱内注射A型肉毒杆菌神经毒素（BoNT/A）可有效治疗顽固性脊髓性神经源性逼尿肌过度活动（NDO），但关于BoNT/A用于特发性逼尿肌过度活动（IDO）患者的报道较少。本研究的目的是调查IDO患者与NDO患者对BoNT/A的反应是否能显示出相当的疗效。
在一项前瞻性、开放标签研究中，因尿动力学证实为顽固性逼尿肌过度活动而出现尿急和/或急迫性尿失禁的患者，采用微创门诊技术将300单位（NDO）或200单位（IDO）的保妥适注射到膀胱中。比较两组患者基线时以及治疗后4周和16周时尿动力学最大膀胱测压容量、充盈期最大逼尿肌压力、排尿频率（排尿次数）、尿失禁发作次数（漏尿次数）以及每24小时与尿急相关的排尿次数（尿急次数），这些数据来自4天的排尿日记。
共治疗了44例脊髓性NDO患者和31例IDO患者。在16周时，NDO组平均±标准误最大膀胱测压容量从229.1±24.8 ml增加到427.0±26.9 ml，p<0.0001；IDO组从193.6±24.0 ml增加到327.1±36.1 ml，p=0.0008。NDO组充盈期最大逼尿肌压力从60.7±6.8 cmH₂O降至26.1±3.7 cmH₂O，p<0.0001；IDO组从62.1±10.8 cmH₂O降至45.1±8.1 cmH₂O，p=0.027。排尿次数从NDO组每24小时12.3±0.7次降至6.6±0.6次，p<0.0001；IDO组从13.6±1.1次降至8.3±0.7次，p=0.0002。漏尿次数从NDO组每24小时3.9±0.5次降至0.7±0.2次，p<0.0001；IDO组从3.2±0.8次降至0.6±0.3次，p=0.0017；尿急次数从NDO组每24小时7.5±0.6次降至1.44±0.3次，p<0.0001；IDO组从10.9±1.7次降至4.9±1.1次，p<0.0001。两组基线数据具有可比性，但NDO患者在4周（78.2%对56.3%，p=0.019）和16周（78.3%对50.7%，p=0.013）时尿急改善百分比更高。NDO组69%的患者治疗后需要重新开始自我导尿，而IDO组为19.3%。
顽固性IDO患者膀胱内注射BoNT/A后，尿动力学和下尿路症状参数的改善与脊髓性NDO患者同样显著，尽管使用的毒素剂量较低。
