Patterson Jacob M, Chapple Christopher R
Department of Urology, Section of Female Urology, Urodynamics and Reconstructive Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
Curr Opin Urol. 2006 Jul;16(4):255-60. doi: 10.1097/01.mou.0000232046.87803.57.
In recent years, botulinum toxin has been investigated for treatment of lower urinary tract dysfunction. This review discusses recently published literature related to the role of botulinum toxin in treating incontinence, including the place for repeated treatment, the differing types of toxin available and the side effects of its use.
Botulinum toxin is safe and effective in improving both urodynamic and subjective parameters. The A serotype has a longer duration of action than the B serotype and has fewer systemic side effects; hence, it is more likely to gain favour as a suitable treatment, both in patients with neurogenic detrusor overactivity and those with idiopathic detrusor overactivity. It is especially effective in reducing incontinence associated with detrusor overactivity, and repeated treatments appear safe and efficacious. A better understanding of urothelial physiology suggests that botulinum toxin not only has efferent effects but also acts on afferent pathways. The existing data as they stand at present would also suggest it to be safe in patients of all age groups.
Botulinum toxin is awaiting approval for use in lower urinary tract dysfunction. Studies have been carried out in varying populations, but few have used reduction in incontinence episodes as a primary end point. The short-term and long-term efficacy and safety of botulinum toxin as a treatment modality for those with lower urinary tract dysfunction, especially for those with detrusor overactivity refractory to anticholinergics, is, however, evidenced increasingly. Further investigation is needed, specifically large randomized placebo-controlled trials, to determine the ideal conditions for the use of botulinum toxin. Some such trials are underway and we look forward to their findings with interest.
近年来，肉毒杆菌毒素已被研究用于治疗下尿路功能障碍。本综述讨论了最近发表的与肉毒杆菌毒素在治疗尿失禁中的作用相关的文献，包括重复治疗的地位、可用的不同毒素类型及其使用的副作用。
肉毒杆菌毒素在改善尿动力学和主观参数方面是安全有效的。A型肉毒杆菌毒素的作用持续时间比B型长，且全身副作用较少；因此，它更有可能成为神经源性逼尿肌过度活动患者和特发性逼尿肌过度活动患者的合适治疗方法。它在减少与逼尿肌过度活动相关的尿失禁方面特别有效，重复治疗似乎是安全有效的。对尿路上皮生理学的更好理解表明，肉毒杆菌毒素不仅具有传出效应，还作用于传入途径。目前现有的数据也表明它在所有年龄组的患者中都是安全的。
肉毒杆菌毒素正在等待批准用于治疗下尿路功能障碍。已经在不同人群中进行了研究，但很少有研究将减少尿失禁发作作为主要终点。然而，越来越多的证据表明，肉毒杆菌毒素作为下尿路功能障碍患者，特别是对抗胆碱能药物难治的逼尿肌过度活动患者的一种治疗方式，其短期和长期疗效及安全性。需要进一步研究，特别是大型随机安慰剂对照试验，以确定使用肉毒杆菌毒素的理想条件。一些这样的试验正在进行中，我们期待着它们的研究结果。
