Sahai Arun, Khan Mohammad Shamim, Le Gall Nicolas, Dasgupta Prokar
Department of Urology, Guy's Hospital and Kings College London School of Medicine, London, United Kingdom.
Urology. 2008 Mar;71(3):455-9. doi: 10.1016/j.urology.2007.11.039.
Botulinum toxin-A (BTX-A) is effective in treating overactive bladder (OAB) refractory to anticholinergics. Most patients have improvements in symptoms, urodynamic parameters, and quality of life, and a poor response is uncommon. The aim of this study was to determine whether poor responders could be predicted from preoperative urodynamic parameters.
Data were collected prospectively from 33 OAB patients with idiopathic detrusor overactivity. All patients underwent intradetrusor injections of 200 U BTX-A. Response to treatment was assessed by patient perception, OAB symptoms, and quality of life data. Urodynamics were conducted at baseline and 4, 12, and 24 weeks postinjection. We performed statistical analysis using the Wilcoxon matched pairs, Mann-Whitney, two-sample, and paired t-tests. Receiver operator characteristic (ROC) curves were plotted for relevant parameters.
Five patients had a poor response to treatment. Significant increases in maximum cystometric capacity (MCC), reflex detrusor volume (RDV), and bladder compliance with decreases in maximum detrusor pressures (MDP) on filling were observed in the responders over 24 weeks. Minimal urodynamic benefit was observed in the poor responders group over the same period. When comparing the two groups, baseline MDP in poor responders was 138.0 +/- 30.7 compared with 74.4 +/- 32.6 in the responders (P = 0.0028). ROC analysis suggested that a pretreatment MDP greater than 110 may have predictive value (AUC, 0.946; sensitivity, 0.86; specificity, 1.0) for a poor response to treatment.
Very high MDP greater than 110 may predict a poor response to treatment with 200 U of BTX-A. Higher doses may be necessary in these patients.
肉毒杆菌毒素A（BTX-A）在治疗对抗胆碱能药物难治的膀胱过度活动症（OAB）方面有效。大多数患者的症状、尿动力学参数及生活质量都有改善，反应不佳的情况并不常见。本研究的目的是确定能否根据术前尿动力学参数预测反应不佳者。
前瞻性收集33例特发性逼尿肌过度活动的OAB患者的数据。所有患者均接受膀胱逼尿肌内注射200 U BTX-A。通过患者感受、OAB症状及生活质量数据评估治疗反应。在基线及注射后4周、12周和24周进行尿动力学检查。我们使用Wilcoxon配对、Mann-Whitney、双样本和配对t检验进行统计分析。绘制相关参数的受试者操作特征（ROC）曲线。
5例患者治疗反应不佳。在24周内，反应良好者的最大膀胱测压容量（MCC）、反射性逼尿肌容量（RDV）及膀胱顺应性显著增加，充盈时最大逼尿肌压力（MDP）降低。同期反应不佳者组尿动力学获益极小。两组比较时，反应不佳者的基线MDP为138.0±30.7，而反应良好者为74.4±32.6（P = 0.0028）。ROC分析表明，治疗前MDP大于110可能对治疗反应不佳具有预测价值（曲线下面积[AUC]为0.946；敏感性为0.86；特异性为1.0）。
大于110的非常高的MDP可能预示对200 U BTX-A治疗反应不佳。这些患者可能需要更高剂量。
