Department of Urology, University of California Los Angeles, Los Angeles, California, USA.
J Urol. 2010 Jun;183(6):2258-64. doi: 10.1016/j.juro.2010.02.009. Epub 2010 Apr 18.
We systematically reviewed the evidence for the efficacy and safety of botulinum toxin in the management of overactive bladder.
We performed a systematic review of the literature to identify articles published between 1985 and March 2009 on intravesical botulinum toxin-A injections for the treatment of refractory idiopathic overactive bladder in men and women. Databases searched included MEDLINE, CENTRAL and Embase. Data were tabulated from case series and from randomized controlled trials, and data were pooled where appropriate.
Our literature search identified 432 titles and 23 full articles were included in the final review. Three randomized placebo controlled trials addressing the use of botulinum toxin-A were identified (99 patients total). The pooled random effects estimate of effect across all 3 studies was 3.88 (95% CI -6.15, -1.62), meaning that patients treated with botulinum toxin-A had 3.88 fewer incontinence episodes per day. Urogenital Distress Inventory data revealed significant improvements in quality of life compared with placebo with a standardized mean difference of -0.62 (CI -1.04, -0.21). Data from case series demonstrated significant improvements in overactive bladder symptoms and quality of life, despite heterogeneity in methodology and case mix. However, based on the randomized controlled trials there was a 9-fold increased odds of increased post-void residual after botulinum toxin-A compared with placebo (8.55; 95% CI 3.22, 22.71).
Intravesical injection of botulinum toxin resulted in improvement in medication refractory overactive bladder symptoms. However, the risk of increased post-void residual and symptomatic urinary retention was significant. Several questions remain concerning the optimal administration of botulinum toxin-A for the patient with overactive bladder.
系统评价肉毒毒素治疗逼尿肌过度活动症的疗效和安全性。
检索 1985 年至 2009 年 3 月期间发表的关于膀胱内注射肉毒毒素 A 治疗男性和女性难治性特发性逼尿肌过度活动症的文章，采用系统评价方法。检索的数据库包括 MEDLINE、CENTRAL 和 Embase。对病例系列和随机对照试验的数据进行制表，并在适当的情况下进行汇总。
文献检索共获得 432 个标题，最终纳入 23 篇全文进行分析。共纳入 3 项关于肉毒毒素 A 治疗的随机安慰剂对照试验（共 99 例患者）。对这 3 项研究进行汇总的随机效应估计结果为 3.88（95%CI-6.15，-1.62），即与安慰剂相比，接受肉毒毒素 A 治疗的患者每天的失禁发作次数减少 3.88 次。尿生殖窘迫量表的评分显示，与安慰剂相比，患者的生活质量有显著改善，标准化均数差为-0.62（CI-1.04，-0.21）。病例系列研究显示，尽管方法学和病例组合存在异质性，但逼尿肌过度活动症症状和生活质量仍有显著改善。然而，基于随机对照试验，与安慰剂相比，肉毒毒素 A 治疗后发生残余尿增加的几率增加了 9 倍（8.55；95%CI3.22，22.71）。
膀胱内注射肉毒毒素可改善药物难治性逼尿肌过度活动症的症状。然而，残余尿增加和症状性尿潴留的风险显著增加。对于患有逼尿肌过度活动症的患者，关于肉毒毒素 A 的最佳给药方式仍有一些问题需要解决。
