Giannantoni Antonella, Porena Massimo, Costantini Elisabetta, Zucchi Alessandro, Mearini Luigi, Mearini Ettore
Department of Urology and Andrology, University of Perugia, Policlinico Monteluce, Perugia, Italy.
J Urol. 2008 Mar;179(3):1031-4. doi: 10.1016/j.juro.2007.10.032. Epub 2008 Jan 18.
We evaluated the 1-year efficacy and tolerability of botulinum A toxin intravesically injected in patients with painful bladder symptoms associated with increased urinary frequency, refractory to conventional treatments.
Three men and 12 women were prospectively included in the study. Under short general anesthesia the patients were given injections of 200 U commercially available botulinum A toxin diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the bladder trigone and lateral walls under cystoscopic guidance. A voiding chart and the visual analog scale for pain were used, and urodynamics were performed before treatment, and 1, 3, 5 and 12 months later.
Overall 13 patients (86.6%) reported subjective improvement at the 1 and 3-month followups. The mean visual analog scale score, and daytime and nighttime urinary frequency were significantly decreased (p <0.05, <0.01 and <0.05, respectively). At the 5-month followup the beneficial effects persisted in 26.6% of cases but increased daytime and nighttime urinary frequency, and an increased visual analog scale score were observed compared to baseline. At 12 months after treatment pain recurred in all patients. Nine patients complained of dysuria 1 month after treatment. Dysuria persisted in 4 cases at the 3-month followup and in 2 at the 5-month followup.
Intravesically injected botulinum toxin A is effective for short-term management of refractory painful bladder syndrome. The beneficial effects decreased progressively within a few months after treatment. Thus, repeat injections of the neurotoxin are required for efficacious treatment in patients with the disease.
我们评估了膀胱内注射A型肉毒杆菌毒素对常规治疗无效的、伴有尿频增加的疼痛性膀胱症状患者的1年疗效和耐受性。
前瞻性纳入3名男性和12名女性患者进行研究。在短暂全身麻醉下，给患者注射200 U市售A型肉毒杆菌毒素，用20 ml 0.9%氯化钠稀释。在膀胱镜引导下，于膀胱三角区和侧壁黏膜下进行注射。使用排尿图表和疼痛视觉模拟量表，并在治疗前、治疗后1、3、5和12个月进行尿动力学检查。
总体而言，13名患者（86.6%）在1个月和3个月随访时报告主观症状改善。疼痛视觉模拟量表评分、白天和夜间尿频均显著降低（分别为p<0.05、<0.01和<0.05）。在5个月随访时，26.6%的病例仍有有益效果，但与基线相比，白天和夜间尿频增加，疼痛视觉模拟量表评分升高。治疗12个月后，所有患者疼痛复发。9名患者在治疗后1个月出现排尿困难。排尿困难在3个月随访时4例持续存在，5个月随访时2例持续存在。
膀胱内注射A型肉毒杆菌毒素对难治性疼痛性膀胱综合征的短期治疗有效。治疗后几个月内有益效果逐渐降低。因此，对于该疾病患者，需要重复注射神经毒素以进行有效治疗。
