Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada; St. Joseph's Health Care, Parkwood Hospital, London, ON, Canada.
Arch Phys Med Rehabil. 2012 Apr;93(4):597-603. doi: 10.1016/j.apmr.2011.11.020. Epub 2012 Feb 24.
To conduct a systematic review and meta-analysis to examine the effect of injecting botulinum toxin A (BTX-A) into the detrusor sphincter on improving bladder emptying in individuals with spinal cord injury (SCI).
MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to September 2011.
All trials examining the use of BTX-A injections into the detrusor sphincter for the treatment for incomplete bladder emptying after SCI were included if at least 50% of the study sample comprised subjects with SCI, and if the SCI sample size was 3 or greater.
A standardized mean difference (SMD) ± SE and 95% confidence interval (CI) were calculated for each outcome of interest, and the results were pooled using a fixed or random effects model, as appropriate. Outcomes assessed included postvoid residual urine volume (PRV), detrusor pressure (PDet), and urethral pressure (UP). Effect sizes were interpreted as small, 0.2; moderate, 0.5; and large, 0.8.
A relatively limited number of studies (2 randomized controlled trials, 6 uncontrolled trials) were identified. The 8 studies included results from 129 subjects. There was a statistically significant decrease in PRV at 1 month (SMD=1.119±.140; 95% CI, .844-1.394; P<.001), with a pooled mean PRV decrease from 251.8 to 153.0 mL. There was a moderate statistical effect on PDet (SMD=.570±.217; 95% CI, .145-.995; P=.009); pooled PDet decreased from 88.7 to 20.5 cmH(2)O. A large statistical effect size on UP (SMD=.896±.291; 95% CI, .327-1.466; P=.002) and an improvement from 119.7 to 102.3 cmH(2)O were seen. The systematic review also indicated a 50% reduction in urinary tract infections based on 3 studies. Discontinuation or reduction in catheter usage was reported in 4 studies after BTX-A.
Results of the meta-analysis indicate that BTX-A is effective in reducing PRV and demonstrating a statistically significant reduction in PDet and UP 1 month postinjection. However, the clinical utility of BTX-A is yet to be determined.
系统回顾和荟萃分析以评估在脊髓损伤（SCI）个体中注射肉毒杆菌毒素 A（BTX-A）到逼尿肌括约肌以改善膀胱排空的效果。
从 1980 年至 2011 年 9 月，检索 MEDLINE、CINAHL、EMBASE 和 PsycINFO 数据库，以获取所有相关文章。
如果至少 50%的研究样本由 SCI 患者组成，并且 SCI 样本量为 3 或更大，则将所有检查使用 BTX-A 注射到逼尿肌括约肌治疗 SCI 后不完全膀胱排空的试验均包括在内。
为每个感兴趣的结局计算标准化均数差（SMD）± SE 和 95%置信区间（CI），并使用固定或随机效应模型适当汇总结果。评估的结局包括残余尿量（PRV）、逼尿肌压力（PDet）和尿道压力（UP）。效应大小的解释为小，0.2；中，0.5；大，0.8。
确定了相对较少的研究（2 项随机对照试验，6 项非对照试验）。8 项研究包括 129 名患者的结果。1 个月时 PRV 有统计学意义的下降（SMD=1.119±.140；95%CI，.844-1.394；P<.001），平均 PRV 从 251.8 下降至 153.0 mL。PDet 有中度统计学效应（SMD=.570±.217；95%CI，.145-.995；P=.009）；PDet 从 88.7 下降至 20.5 cmH2O。UP 有较大的统计学效应（SMD=.896±.291；95%CI，.327-1.466；P=.002），从 119.7 下降至 102.3 cmH2O。系统综述还表明，基于 3 项研究，尿路感染减少了 50%。BTX-A 后，4 项研究报告说停止或减少了导尿管的使用。
荟萃分析结果表明，BTX-A 可有效减少 PRV，并在注射后 1 个月时显示出 PDet 和 UP 的统计学显著降低。然而，BTX-A 的临床效用尚待确定。
