Mahfouz Wally, Karsenty Gilles, Corcos Jacques
Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Can J Urol. 2011 Aug;18(4):5787-95.
The first application of botulinum toxin type A (BoNT-A) in urology was its injection into the urinary sphincter to treat neurogenic detrusor-sphincter dyssynergia (DSD) in quadriplegic men. Since that first report by Dyskatra et al in 1988, the results of focal BTA injections into the sphincter, the bladder wall and lately into the prostate have raised the interest of the urology community in this promising new therapeutic modality. This is an evidence-based review of the current indications, techniques and outcomes of BTA injections into the urethral sphincter.
The Medline database was searched for the period between 1966 and October 2010, using the keywords 'botulinum toxin' and 'urethra' or 'urethral sphincter'. English written articles ere selected. A level of evidence according to the Oxford Centre for evidence-based medicine was assigned to each article.
Since our first review in 2006, very little has been added to the literature on the use of botulinum toxin injected into the external sphincter. At present, those most likely to benefit from intrasphincteric BTA injection are MS patients suffering the symptoms of DSD and quadriplegic men with DSD unable to perform self-catheterization. Well developed and conducted studies are necessary; these must be done urgently to better define the place and the results of this drug otherwise widely used in other indications in urology.
A型肉毒杆菌毒素（BoNT-A）在泌尿外科的首次应用是将其注射到尿道括约肌，用于治疗四肢瘫痪男性的神经源性逼尿肌-括约肌协同失调（DSD）。自1988年戴斯卡特拉等人首次报道以来，向括约肌、膀胱壁以及最近向前列腺进行局部肉毒杆菌毒素A（BTA）注射的结果，引起了泌尿外科界对这种有前景的新治疗方式的关注。这是一篇基于证据的关于向尿道括约肌注射BTA的当前适应证、技术和结果的综述。
检索1966年至2010年10月期间的Medline数据库，使用关键词“肉毒杆菌毒素”和“尿道”或“尿道括约肌”。选择英文撰写的文章。根据牛津循证医学中心的标准为每篇文章确定证据水平。
自我们2006年首次综述以来，关于向尿道外括约肌注射肉毒杆菌毒素的文献新增内容很少。目前，最有可能从括约肌内注射BTA中获益的是患有DSD症状的多发性硬化症患者以及患有DSD且无法自行导尿的四肢瘫痪男性。需要开展完善且实施良好的研究；必须尽快进行这些研究，以更好地明确这种在泌尿外科其他适应证中广泛使用的药物的地位和疗效。
