Jeffery Stephen, Fynes Michelle, Lee Frank, Wang Kate, Williams Lin, Morley Roland
Department of Urogynaecology and Pelvic Floor Reconstruction, St George's Hospital, London, UK.
BJU Int. 2007 Dec;100(6):1302-6. doi: 10.1111/j.1464-410X.2007.07186.x.
To evaluate the efficacy and complications of botulinum A toxin (Dysport, Ipsen Ltd, Slough, UK) 500 U in refractory idiopathic detrusor overactivity (IDO).
In a prospective study of 25 patients with refractory IDO, the baseline evaluation included an assessment of symptoms, a 7-day voiding diary, 24-h pad test, record of symptoms on a visual analogue scale (VAS) (0-10), the Kings Health Questionnaire (KHQ) and urodynamics. Dysport 500 U was administered at 20 sites in the bladder, sparing the trigone. Patients were followed at 6 weeks and 3, 6 and 9 months; the urodynamic assessment was repeated at 3 months.
Fifteen (63%) patients reported being continent from 1 week after treatment; at 3 months, six (32%) (P = 0.01) patients were still dry, remaining so at 6 months (P = 0.025). Weekly leakage episodes decreased from 5.5 to 1.8 (P = 0.044) at 6 weeks and this was sustained, at 2.7 episodes (P = 0.012), at 9 months. The mean VAS score (0-10) decreased from 8.3 to 5.0 (P = 0.001) at 1 week, to 5.0 at 6 weeks (P = 0.001) and 3 months (P = 0.03) and to 6.1 (P = 0.013) at 6 months. On the KHQ there was a significant improvement in the severity measures domain (P = 0.021) and incontinence impact domain (P = 0.015) up to 9 months. The volume at first desire to void increased from 177 to 251 mL (P = 0.04) at 3 months. At 6 weeks and 3 months, 35% of patients required catheterization, as did 22% at 6 months, but only one at 9 months.
Intradetrusor Dysport 500 U was associated with significant subjective and objective improvements in refractory IDO. The present patients initially had a significant increase in voiding dysfunction that resolved by 9 months.
评估500单位A型肉毒毒素（商品名：得保松，益普生有限公司，英国斯劳）治疗难治性特发性逼尿肌过度活动症（IDO）的疗效及并发症。
对25例难治性IDO患者进行前瞻性研究，基线评估包括症状评估、7天排尿日记、24小时护垫试验、视觉模拟评分法（VAS，0 - 10分）记录症状、国王健康问卷（KHQ）及尿动力学检查。在膀胱20个部位注射500单位得保松，避开三角区。患者分别在6周、3个月、6个月和9个月进行随访；3个月时重复尿动力学评估。
15例（63%）患者在治疗1周后报告无尿失禁；3个月时，6例（32%）（P = 0.01）患者仍无尿失禁，6个月时仍保持（P = 0.025）。6周时每周漏尿次数从5.5次降至1.8次（P = 0.044），并持续至9个月时的2.7次（P = 0.012）。VAS平均评分（0 - 10分）在1周时从8.3分降至5.0分（P = 0.001），6周时为5.0分（P = 0.001），3个月时为5.0分（P = 0.03），6个月时为6.1分（P = 0.013）。在KHQ上，直至9个月，严重程度测量领域（P = 0.021）和尿失禁影响领域（P = 0.015）有显著改善。3个月时首次有排尿欲望时的尿量从177毫升增至251毫升（P = 0.04）。6周和3个月时，35%的患者需要导尿，6个月时为22%，但9个月时仅1例。
膀胱内注射500单位得保松可使难治性IDO患者在主观和客观方面有显著改善。本研究中的患者最初排尿功能障碍显著增加，但在9个月时得到缓解。
