Krivoborodov G G, Vasil'ev A V, Shumilo D V, Ivanov A V, Tur E I
Urologiia. 2010 May-Jun(3):36-40.
The aim of the study was to investigate safety and efficacy of intradetrusor injection of 100 units of botulinum toxin type A in 26 patients with refractory overactive bladder. The diagnostic scheme consisted of 72 h diary, laboratory tests, ultrasound investigation with measurement of residual urine, urodynamic investigation and neurological examination. The patients were divided into 3 groups: 14 patients with idiopathic detrusor overactivity (DO), 9 with neurogenic DO, and 6 with overactive bladder without DO. 100 units of botulinum toxin type A mixed with 20 ml of normal saline were injected into the detrusor sparing the trigone. Clinical and urodynamic evaluations were performed before the injection and 1, 3 and 6 months after it. The patients with idiopathic DO and overactive bladder without DO showed improvement of such clinical symptoms as frequency, urgency, nocturia and urgent incontinence which lasted for at least 6 months. Patients with neurogenic DO had improvement of the clinical symptoms only for one month after treatment. We had no patients who exhibited acute urinary retention or residual urine. Thus, 100 units of botulinum toxin type A injected into the detrusor is an effective, safe and well tolerated treatment for patients with idiopathic DO and overactive bladder without DO in whom an anticholinergic medication has failed.
本研究的目的是调查向26例难治性膀胱过度活动症患者膀胱逼尿肌内注射100单位A型肉毒杆菌毒素的安全性和有效性。诊断方案包括72小时排尿日记、实验室检查、测量残余尿量的超声检查、尿动力学检查和神经学检查。患者被分为3组：14例特发性逼尿肌过度活动（DO）患者、9例神经源性DO患者和6例无DO的膀胱过度活动症患者。将100单位A型肉毒杆菌毒素与20毫升生理盐水混合后注射到逼尿肌，避开三角区。在注射前以及注射后1、3和6个月进行临床和尿动力学评估。特发性DO患者和无DO的膀胱过度活动症患者的尿频、尿急、夜尿症和急迫性尿失禁等临床症状得到改善，且持续至少6个月。神经源性DO患者治疗后临床症状仅在1个月内有所改善。我们没有患者出现急性尿潴留或残余尿量。因此，对于抗胆碱能药物治疗失败的特发性DO患者和无DO的膀胱过度活动症患者，向逼尿肌内注射100单位A型肉毒杆菌毒素是一种有效、安全且耐受性良好的治疗方法。
