Schurch B, Hauri D, Largo M, Kreienbühl B, Meyer E, Rossier A B
Centre Suisse de Paraplégiques, Clinique Universitaire d'Orthopédie Balgrist, Zurich.
J Urol (Paris). 1990;96(7):375-80.
The goal of this study was to try to determine the effects of the Botulinum A Toxin on the spasticity of the rhabdosphincter in 9 men with spinal cord injury and detrusor-sphincter dyssynergia. The cystometrography, before and after the endoscopic injection of 100 units of Botulinum A Toxin, consisted of recording the bladder, urethral and rectal pressures with microtip transducers the anatomical position of which was radiographically controlled. The subjective and objective results of that study allow us to conclude that the Botulinum A Toxin has a place in the treatment of spinal injuries with detrusor-sphincter dyssynergia. Due to his blocking effect on the release of acetylcholine in the motor nerve endings, the Botulinum A Toxin suppresses or decreases the spasticity of the rhabdosphincter and improves voiding. Although its relatively short living action (2-3 months) may require renewed injections, it has the advantage to hold off a surgical treatment such as a sphincterotomy and to give the patient another chance to reach a balanced bladder function secondary to the postinjection changes of reflexes which may have taken place between the bladder and the rhabdosphincter and vice versa.
本研究的目的是试图确定A型肉毒杆菌毒素对9名脊髓损伤并伴有逼尿肌-括约肌协同失调的男性患者横纹括约肌痉挛的影响。在内镜下注射100单位A型肉毒杆菌毒素前后进行膀胱压力描记，通过微尖端换能器记录膀胱、尿道和直肠压力，其解剖位置由X射线控制。该研究的主观和客观结果使我们得出结论，A型肉毒杆菌毒素在治疗伴有逼尿肌-括约肌协同失调的脊髓损伤中占有一席之地。由于其对运动神经末梢乙酰胆碱释放的阻断作用，A型肉毒杆菌毒素可抑制或减轻横纹括约肌的痉挛并改善排尿。尽管其作用持续时间相对较短（2 - 3个月）可能需要再次注射，但它具有避免诸如括约肌切开术等手术治疗的优势，并能使患者有机会因注射后膀胱与横纹括约肌之间可能发生的反射变化而达到平衡的膀胱功能，反之亦然。
