Poon Christina I, Zimmern Philippe E
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Urology. 2006 Apr;67(4):725-9; discussion 729-30. doi: 10.1016/j.urology.2005.10.066.
To investigate the effectiveness of periurethral collagen injection (PCI) in patients presenting with symptoms of mixed urinary incontinence (MUI) and urodynamically demonstrated sphincter deficiency and detrusor overactivity.
A retrospective review was performed on all patients undergoing PCI from February 1999 to February 2003, during which those with MUI were treated with PCI as first-line therapy. The inclusion criteria were MUI symptoms, detrusor overactivity on urodynamic study, stress urinary incontinence due to sphincter deficiency (determined from physical examination, stress test, urodynamic study with Valsalva leak point pressure, and cystography findings, without urethral hypermobility). The primary outcome measures were the Urogenital Distress Inventory (UDI), Incontinence Impact Questionnaire, and quality-of-life score and the need for anticholinergic medications or additional surgery. Comparisons were performed using the Wilcoxon signed ranks test and paired t test.
Of the 56 patients who underwent PCI, 43 presented with symptoms of MUI, and 16 of these (29%) had both detrusor overactivity and stress urinary incontinence on urodynamic study. The mean follow-up after PCI (without additional PCI) was 18 months (range 6 to 39). The mean age was 65 years (range 40 to 84). The mean Valsalva leak point pressure was 54 +/- 40 cm H2O (range 18 to 146). Ten patients had undergone previous anti-incontinence procedures, and anticholinergic medications had failed in six. The questionnaire scores, indicating severe MUI/poor quality of life before PCI, improved after PCI: UDI question 1, 2.3 +/- 0.8 versus 1.3 +/- 1.0 (P = 0.021); UDI question 2, 2.1 +/- 1.2 versus 1.4 +/- 1.0 (P = 0.068); UDI question 3, 2.9 +/- 0.4 versus 1.8 +/- 1.2 (P = 0.010); and quality-of-life question, 8.6 +/- 2.1 versus 5.2 +/- 3.5 (P = 0.026). The mean injected volume/patient was 8.5 cm3 (range 5 to 17) within a mean of 1.9 treatments (range 1 to 3). Four patients continued taking anticholinergic medications and one proceeded to sling placement.
The use of PCI as the primary/initial intervention in patients with MUI may be the preferred approach, particularly in patients with an elevated risk of anticholinergic medication side effects or when voiding dynamics preclude sling placement.
探讨尿道周围注射胶原蛋白（PCI）对混合性尿失禁（MUI）患者的疗效，这些患者经尿动力学检查证实存在括约肌功能不全和逼尿肌过度活动。
对1999年2月至2003年2月期间接受PCI治疗的所有患者进行回顾性研究，在此期间，MUI患者接受PCI作为一线治疗。纳入标准为MUI症状、尿动力学检查显示逼尿肌过度活动、因括约肌功能不全导致的压力性尿失禁（根据体格检查、压力试验、Valsalva漏点压尿动力学检查和膀胱造影结果确定，无尿道活动过度）。主要观察指标为泌尿生殖系统困扰量表（UDI）、尿失禁影响问卷、生活质量评分以及对抗胆碱能药物或额外手术的需求。采用Wilcoxon符号秩和检验和配对t检验进行比较。
56例接受PCI治疗的患者中，43例有MUI症状，其中16例（29%）在尿动力学检查中既有逼尿肌过度活动又有压力性尿失禁。PCI后（未进行额外PCI）的平均随访时间为18个月（范围6至39个月）。平均年龄为65岁（范围40至84岁）。平均Valsalva漏点压为54±40 cm H2O（范围18至146）。10例患者曾接受过抗尿失禁手术，6例抗胆碱能药物治疗无效。问卷评分显示，PCI前MUI严重/生活质量差，PCI后有所改善：UDI问题1，2.3±0.8对1.3±1.0（P = 0.021）；UDI问题2，2.1±1.2对1.4±1.0（P = 0.068）；UDI问题3，2.9±0.4对1.8±1.2（P = 0.010）；生活质量问题，8.6±2.1对5.2±3.5（P = 0.026）。每位患者的平均注射量为8.5 cm3（范围5至17），平均治疗次数为1.9次（范围1至3次）。4例患者继续服用抗胆碱能药物，1例进行了吊带置入术。
将PCI作为MUI患者的主要/初始干预措施可能是首选方法，特别是对于抗胆碱能药物副作用风险较高或排尿动力学不适合进行吊带置入的患者。
