White Wesley M, Pickens Ryan B, Doggweiler Regula, Klein Frederick A
Division of Urologic Surgery, University of Tennessee Medical Center, Knoxville, Tennessee 37920, USA.
J Urol. 2008 Dec;180(6):2522-6. doi: 10.1016/j.juro.2008.08.030. Epub 2008 Oct 19.
We determined the efficacy of intravesical botulinum toxin A injection for refractory overactive bladder in elderly patients.
Patients 75 years or older with refractory urinary urgency were prospectively evaluated and offered treatment of symptoms with botulinum toxin A. A voiding log was obtained and urodynamics were performed before treatment. Patients underwent injection of 200 U botulinum toxin A (Botox(R)) into the detrusor muscle at 20 sites under cystoscopic guidance. Patients were followed postoperatively for evidence and duration of success, and treatment related complications.
From January 2006 to June 2007, 18 females and 3 males with a mean age of 81.2 years (range 75 to 92) in whom detrusor overactivity was confirmed on urodynamics and who were refractory to or intolerant of antimuscarinics were treated with intravesical botulinum toxin A. Preoperatively the mean +/- SD number of daily voids was 11.4 +/- 1.67 and the mean number of pads per day was 4.0 +/- 0.89. One month after treatment 16 of the 21 patients (76%) reported greater than 50% improvement in symptoms after 1 injection. Specifically there was a significant improvement in the mean number of voids per day (5.19 +/- 0.83, p <0.001) and in the number of pads used daily (1.3 +/- 0.60, p <0.001). Two of the remaining 5 patients demonstrated greater than 50% improvement following repeat injection, while 3 did not show improvement after 2 injections. Mean time to deterioration was 7.12 months. There were no treatment related complications.
Intravesical botulinum toxin A for detrusor overactivity in the elderly population appears to be efficacious and durable. Given its low incidence of adverse events, it should be considered a viable treatment option in this population.
我们确定了膀胱内注射A型肉毒杆菌毒素治疗老年患者难治性膀胱过度活动症的疗效。
对75岁及以上难治性尿急患者进行前瞻性评估，并提供A型肉毒杆菌毒素治疗症状。在治疗前获取排尿日志并进行尿动力学检查。患者在膀胱镜引导下于20个部位向逼尿肌注射200 U A型肉毒杆菌毒素（保妥适）。术后对患者进行随访，观察成功的证据和持续时间以及治疗相关并发症。
2006年1月至2007年6月，18名女性和3名男性，平均年龄81.2岁（范围75至92岁），经尿动力学证实存在逼尿肌过度活动且对抗胆碱能药物难治或不耐受，接受了膀胱内注射A型肉毒杆菌毒素治疗。术前平均每日排尿次数±标准差为11.4±1.67，每日使用尿垫平均数量为4.0±0.89。治疗1个月后，21例患者中有16例（76%）报告1次注射后症状改善超过50%。具体而言，平均每日排尿次数（5.19±0.83，p<0.001）和每日使用尿垫数量（1.3±0.60，p<0.001）有显著改善。其余5例患者中有2例在重复注射后症状改善超过50%，而3例在2次注射后未显示改善。平均恶化时间为7.12个月。未出现治疗相关并发症。
膀胱内注射A型肉毒杆菌毒素治疗老年人群逼尿肌过度活动似乎有效且持久。鉴于其不良事件发生率低，应被视为该人群可行的治疗选择。
