Gamé Xavier, Castel-Lacanal Evelyne, Bentaleb Youssef, Thiry-Escudié Isabelle, De Boissezon Xavier, Malavaud Bernard, Marque Philippe, Rischmann Pascal
Service d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France.
Eur Urol. 2008 Mar;53(3):613-8. doi: 10.1016/j.eururo.2007.08.039. Epub 2007 Aug 28.
To study the effect of botulinum toxin A (BoNTA) injections into the detrusor muscle on the incidence of symptomatic urinary infections in patients with neurogenic detrusor overactivity.
Between February 2004 and June 2005, 30 patients (18 men, 12 women), mean age 39.4+/-12.1 yr, with neurogenic detrusor overactivity received an injection of 300 U Botox (Allergan Inc., Irvine, CA, USA) into the detrusor. Fifteen patients had multiple sclerosis, 14 had spinal cord injury, and 1 had myelitis. Twenty-two patients had urinary incontinence. Patients were either resistant to anticholinergic medications, had discontinued treatment because of adverse effects, or had contraindications to anticholinergic drugs. Before and 6 wk after injection, each patient kept a bladder diary and underwent urodynamic investigation, retrograde and voiding cystourethrography, and urine culture. All symptomatic urinary infections (pyelonephritis, orchitis, prostatitis) occurring in the 6 mo before and the 6 mo after injection were recorded.
Before injection, the mean number of symptomatic urinary infections over 6 mo was 1.75+/-1.87. After injection, the mean was 0.2+/-0.41 (p=0.003), and only 3 patients presented symptomatic urinary infections. These patients were those who showed less improvement in their urodynamic parameters after injection (volume of the first uninhibited contraction, maximum bladder pressure, and maximum cystometric capacity, respectively; p=0.0037, p=0.0002, p=0.0027, ANOVA).
BoNTA injections into the detrusor muscle significantly decreased the incidence of symptomatic urinary infections. This effect seems to be related to improvement in urodynamic parameters, reflecting improved reservoir capacity at low pressure.
研究向逼尿肌注射A型肉毒杆菌毒素（BoNTA）对神经源性逼尿肌过度活动患者症状性泌尿系统感染发生率的影响。
2004年2月至2005年6月期间，30例（18例男性，12例女性）平均年龄为39.4±12.1岁的神经源性逼尿肌过度活动患者接受了300单位保妥适（美国加利福尼亚州欧文市艾尔建公司）向逼尿肌的注射。15例患者患有多发性硬化症，14例患有脊髓损伤，1例患有脊髓炎。22例患者存在尿失禁。患者要么对抗胆碱能药物耐药，要么因不良反应而停止治疗，要么存在抗胆碱能药物的禁忌证。在注射前及注射后6周，每位患者记录膀胱日记，并接受尿动力学检查、逆行性和排尿性膀胱尿道造影以及尿培养。记录注射前6个月和注射后6个月期间发生的所有症状性泌尿系统感染（肾盂肾炎、睾丸炎、前列腺炎）。
注射前，6个月期间症状性泌尿系统感染的平均次数为1.75±1.87。注射后，平均次数为0.2±0.41（p = 0.003），只有3例患者出现症状性泌尿系统感染。这些患者是注射后尿动力学参数改善较少的患者（首次无抑制收缩量、最大膀胱压力和最大膀胱测压容量，分别为p = 0.0037、p = 0.0002、p = 0.0027，方差分析）。
向逼尿肌注射BoNTA可显著降低症状性泌尿系统感染的发生率。这种效果似乎与尿动力学参数的改善有关，反映出在低压下储尿能力的提高。
