Shaban Ahmed M, Drake Marcus J
Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom.
Curr Urol Rep. 2008 Nov;9(6):445-51. doi: 10.1007/s11934-008-0077-1.
In recent years, botulinum-A neurotoxin has increasingly been used to manage lower urinary tract symptoms, including overactive bladder and detrusor overactivity (DO), either due to neurogenic or idiopathic etiology. Techniques, doses, and preparation vary. Although many studies have reported promising results regarding efficacy, potential adverse effects, particularly urinary retention, have been less comprehensively reported. We performed a critical review of published studies evaluating botulinum treatment for overactive bladder and its reported effects on voiding function. Acute urinary retention is recognized, though rare. Chronic urinary retention is inconsistently reported; it appears to be more common in neurogenic DO, but it can occur in idiopathic DO. Increased postvoid residuals have been reported by several studies, but the clinical significance that investigators attach to the observation varies. The detrimental effect of retention on quality of life can be considerable. Accordingly, patients should be fully counseled on the risks of urinary retention and trained in intermittent catheterization before the procedure. Postvoid residual assessment should be part of follow-up and patients should be warned of possible presentations.
近年来，A型肉毒杆菌神经毒素越来越多地被用于治疗下尿路症状，包括膀胱过度活动症和逼尿肌过度活动（DO），其病因可能是神经源性或特发性。技术、剂量和制剂各不相同。尽管许多研究报告了关于疗效的有前景的结果，但潜在的不良反应，尤其是尿潴留，却较少得到全面报道。我们对已发表的评估肉毒杆菌治疗膀胱过度活动症及其对排尿功能的报道影响的研究进行了严格审查。急性尿潴留虽被认识到，但很罕见。慢性尿潴留的报道并不一致；它似乎在神经源性DO中更常见，但也可能发生在特发性DO中。几项研究报告了排尿后残余尿量增加，但研究人员对这一观察结果的临床意义看法不一。尿潴留对生活质量的有害影响可能相当大。因此，在手术前，应向患者充分告知尿潴留的风险，并对其进行间歇性导尿训练。排尿后残余尿量评估应作为随访的一部分，并且应警告患者可能出现的情况。
