Kuo Hann-Chorng
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Urol Int. 2005;75(3):247-51. doi: 10.1159/000087803.
After radical hysterectomy for cervical cancer patients may have difficulty in urination due to detrusor underactivity and a non-relaxing urethral sphincter. This study evaluated the effectiveness of urethral injection of botulinum A toxin in treating voiding dysfunction in these patients.
Thirty patients with difficult urination after radical hysterectomy due to cervical cancer were enrolled to receive urethral injection of 100 units of botulinum A toxin (n=20) or medical treatment as controls (n=10). The clinical results and urodynamic parameters at baseline and after treatment were compared in the study group, and the quality of life (QOL) index was compared between the study and control groups.
After urethral injection of botulinum A toxin, 8 patients had excellent results (40%) and 8 had improved results (40%) in the study group. Both voiding pressure (115.2+/-63.7 vs. 90.2+/-49.5 ml, p=0.025) and post-void residual volume (330.9+/-124.9 vs. 183.9+/-183.4 ml, p=0.011) improved significantly after treatment. The obstructive symptom score was significantly reduced (17.5+/-4.7 vs. 5.7+/-2.3 points, p=0.000) and the QOL index also improved (4.5+/-2.7 vs. 2.3+/-2.3 points, p=0.000) after treatment. The success rate was 80% in the study group. There were no significant changes in obstructive symptom scores or the QOL index in the control group. The maximal effect appeared about 1 week after treatment. The duration of the therapeutic effect ranged from 3 to 9 months. Mild stress urinary incontinence and nocturnal enuresis were noted in 7 patients (35%).
Urethral injection of botulinum A toxin can be effectively used to treat patients with detrusor underactivity and non-relaxing urethral sphincter after radical hysterectomy with few adverse effects.
宫颈癌患者根治性子宫切除术后可能因逼尿肌活动不足和尿道括约肌不松弛而出现排尿困难。本研究评估尿道注射A型肉毒毒素治疗这些患者排尿功能障碍的有效性。
30例因宫颈癌根治性子宫切除术后排尿困难的患者被纳入研究，其中20例接受尿道注射100单位A型肉毒毒素，10例接受药物治疗作为对照。比较研究组治疗前后的临床结果和尿动力学参数，并比较研究组与对照组的生活质量（QOL）指数。
研究组尿道注射A型肉毒毒素后，8例效果极佳（40%），8例效果改善（40%）。治疗后排尿压力（115.2±63.7 vs. 90.2±49.5 ml，p = 0.025）和残余尿量（330.9±124.9 vs. 183.9±183.4 ml，p = 0.011）均显著改善。梗阻症状评分显著降低（17.5±4.7 vs. 5.7±2.3分，p = 0.000），治疗后QOL指数也有所改善（4.5±2.7 vs. 2.3±2.3分，p = 0.000）。研究组成功率为80%。对照组梗阻症状评分和QOL指数无显著变化。最大效果出现在治疗后约1周。治疗效果持续时间为3至9个月。7例患者（35%）出现轻度压力性尿失禁和夜间遗尿。
尿道注射A型肉毒毒素可有效用于治疗根治性子宫切除术后逼尿肌活动不足和尿道括约肌不松弛的患者，且不良反应较少。
