SARAH Network of Rehabilitation Hospitals, Belo Horizonte Unit, Belo Horizonte, MG, Brazil.
Int Braz J Urol. 2010 Nov-Dec;36(6):732-7. doi: 10.1590/s1677-55382010000600012.
To evaluate the efficacy of botulinum toxin type A injections in the detrusor muscle in patients with spinal cord injury and urinary incontinence due to detrusor overactivity and refractory to anticholinergic agents.
We prospectively evaluated 22 patients with spinal cord injuries, whose bladders were emptied by intermittent catheterization. All patients had detrusor overactivity and urinary incontinence that proved difficult to treat, despite using high doses of two different anticholinergics. The pre-treatment assessment included a complete urodynamic study and ultrasonography of the kidneys and urinary tract. A one-month follow-up was completed with urodynamic evaluation and the clinical response was evaluated through outpatient consultations and telephone contact.
After the procedure, the maximum cystometric capacity and the bladder reflex volume increased, whereas the maximum detrusor pressure and compliance decreased. The mean duration of continence was 7±7 months. In 18 patients (81.8%), it was necessary to administer anticholinergics to achieve continence. Five patients (22.7%) had indication of reinjection, and augmentation cystoplasty was indicated in 9 patients (40.9%).
The use of botulinum toxin in the treatment of neurogenic detrusor overactivity refractory to anticholinergics is an option before more invasive treatments, such as augmentation cystoplasty, are attempted. In our study as well as in the literature, there was improvement in most urodynamic parameters. Overall, 40.9% of patients underwent augmentation cystoplasty and 81.8% of patients needed anticholinergic agents to reach urinary continence. Further studies are necessary to improve the procedure and to achieve better clinical results.
评估 A 型肉毒毒素注射治疗逼尿肌对脊髓损伤患者逼尿肌过度活动和抗胆碱能药物难治性尿失禁的疗效。
我们前瞻性评估了 22 例脊髓损伤患者，其膀胱通过间歇性导尿排空。所有患者均有逼尿肌过度活动和难以治疗的尿失禁，尽管使用了两种不同的高剂量抗胆碱能药物。治疗前评估包括完整的尿动力学研究和肾脏及尿路超声检查。通过尿动力学评估和门诊咨询及电话联系评估临床反应完成一个月的随访。
治疗后，最大膀胱容量和膀胱反射容量增加，而最大逼尿肌压力和顺应性降低。平均持续时间为 7±7 个月。在 18 名患者（81.8%）中，需要给予抗胆碱能药物才能保持尿失禁。有 5 名患者（22.7%）需要再次注射，9 名患者（40.9%）需要进行膀胱扩大术。
在尝试更具侵袭性的治疗方法（如膀胱扩大术）之前，肉毒毒素在治疗抗胆碱能药物难治性神经源性逼尿肌过度活动中的应用是一种选择。在我们的研究以及文献中，大多数尿动力学参数都有所改善。总体而言，40.9%的患者接受了膀胱扩大术，81.8%的患者需要抗胆碱能药物才能达到尿失禁。需要进一步研究以改善该手术并获得更好的临床结果。
