Dykstra D D, Sidi A A
Department of PM&R, University of Minnesota Hospital and Clinic, Minneapolis.
Arch Phys Med Rehabil. 1990 Jan;71(1):24-6.
The ability of botulinum A toxin to denervate and relax a spastic external urethral sphincter was evaluated in a double-blind study involving five men with high spinal cord injuries and detrusor-sphincter dyssynergia. The sphincter was injected with either a low dose of botulinum A toxin or normal saline once per week for three weeks. Electromyography of the external urethral sphincter indicated denervation in the three patients who received toxin injections. The urethral pressure profile decreased an average of 25cm of water, postvoiding residual volume of urine decreased an average of 125cc, and bladder pressure during voiding decreased to an average of 30cm of water. Bulbosphincteric reflexes were more difficult to obtain, and they showed a decreased amplitude with normal latency. In the two patients who received normal saline injections, parameters were unchanged from baseline values until subsequent injection with botulinum A toxin once per week for three weeks when their responses were similar to those of the other three patients. Mild generalized weakness lasting two to three weeks was noted by three patients after initial toxin injections. The duration of the toxin's effect averaged two months. The results suggest that botulinum A toxin, an inhibitor of acetylcholine release at the neuromuscular junction, may be useful in the treatment of detrusor-sphincter dyssynergia.
在一项双盲研究中，对5名患有高位脊髓损伤和逼尿肌-括约肌协同失调的男性进行了评估，以确定A型肉毒杆菌毒素使痉挛性尿道外括约肌失神经支配并放松的能力。每周一次向括约肌注射低剂量A型肉毒杆菌毒素或生理盐水，持续三周。尿道外括约肌的肌电图显示，接受毒素注射的3名患者出现了失神经支配。尿道压力曲线平均下降25厘米水柱，排尿后残余尿量平均减少125立方厘米，排尿时膀胱压力平均降至30厘米水柱。球海绵体肌反射更难引出，且潜伏期正常，但幅度降低。在接受生理盐水注射的2名患者中，各项参数在后续每周一次注射A型肉毒杆菌毒素持续三周之前均与基线值无变化，此时他们的反应与其他3名患者相似。3名患者在首次注射毒素后出现了持续两到三周的轻度全身无力。毒素作用的持续时间平均为两个月。结果表明，作为神经肌肉接头处乙酰胆碱释放抑制剂的A型肉毒杆菌毒素，可能对治疗逼尿肌-括约肌协同失调有用。
