Kalsi Vinay, Gonzales Gwen, Popat Roshni, Apostolidis Apostolos, Elneil Sohier, Dasgupta Prokar, Fowler Clare J
Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Ann Neurol. 2007 Nov;62(5):452-7. doi: 10.1002/ana.21209.
Our objective was to demonstrate the efficacy and impact on quality of life of detrusor injections of botulinum neurotoxin type A in the treatment of bladder dysfunction in patients with multiple sclerosis.
Forty-three patients with multiple sclerosis suffering from severe urgency incontinence were treated with detrusor injections of botulinum neurotoxin type A. Data from cystometric assessment of the bladder, voiding diaries, quality-of-life questionnaires, and procontinence medication usage were collected before treatment and 4 and 16 weeks after injection. The same data were also collected after repeat treatments.
Highly significant improvements (p < 0.0001) in incontinence episodes and urinary urgency, daytime frequency and nocturia, were the symptomatic reflection of the significant improvements in urodynamically demonstrated bladder function. Although 98% of patients had to perform self-catheterization after treatment, there were sustained improvements in all quality-of-life scores. The mean duration of effect was 9.7 months. Similar results were seen with repeat treatments.
Minimally invasive injections of botulinum neurotoxin type A have been shown to be exceptionally effective in producing a prolonged improvement in urinary continence in patients with multiple sclerosis. This treatment is likely to have a major impact on future management.
我们的目的是证明A型肉毒杆菌神经毒素膀胱逼尿肌注射治疗多发性硬化症患者膀胱功能障碍的疗效及对生活质量的影响。
43例患有严重急迫性尿失禁的多发性硬化症患者接受了A型肉毒杆菌神经毒素膀胱逼尿肌注射治疗。在治疗前以及注射后4周和16周收集膀胱测压评估、排尿日记、生活质量问卷和控尿药物使用情况的数据。重复治疗后也收集相同的数据。
尿失禁发作、尿急、日间排尿频率和夜尿症有极显著改善（p<0.0001），这是尿动力学显示的膀胱功能显著改善的症状表现。尽管98%的患者在治疗后必须进行自我导尿，但所有生活质量评分均持续改善。平均疗效持续时间为9.7个月。重复治疗也有类似结果。
已证明微创注射A型肉毒杆菌神经毒素在使多发性硬化症患者尿失禁得到长期改善方面异常有效。这种治疗可能会对未来的治疗管理产生重大影响。
