Department of Urology, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, Buddhist Tzu Chi General Hospital (HCK) and Tzu Chi University (HCK), Hualien, Taiwan, Republic of China.
J Urol. 2013 May;189(5):1804-10. doi: 10.1016/j.juro.2012.11.089. Epub 2012 Nov 20.
Intravesical injection of onabotulinumtoxinA is effective for idiopathic detrusor overactivity refractory to antimuscarinics. However, safety is a major concern, especially in elderly individuals. We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity in the frail elderly population.
A total of 166 patients with urodynamic idiopathic detrusor overactivity refractory to previous antimuscarinics for more than 3 months received 1 intravesical 100 U onabotulinumtoxinA injection from 2004 to 2009. Frail elderly was defined as age greater than 65 years and 3 or more of certain criteria, including unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and/or low physical activity. Treatment results were assessed by the Patient Perception of Bladder Condition, voiding diary, urodynamic parameters and Kaplan-Meier estimates of survival plots.
We evaluated 61 frail elderly patients, 63 who were elderly without frailty and 42 younger than 65 years. Large post-void residual urine volume (greater than 150 ml) after onabotulinumtoxinA injection was significantly higher in the frail elderly group than in the other groups (60.7% vs 39.7% and 35.7%, respectively, p = 0.018). Urinary retention developed in 7 frail elderly patients (11.5%), 4 (6.3%) who were elderly without frailty and 1 younger patient (2.4%) (p = 0.203). Recovery duration was significantly longer in frail elderly patients. The cumulative success rate was significantly lower in the frail elderly group than in the other 2 groups (p = 0.009).
Although safety and efficacy were similar between elderly patients without frailty and younger patients, an increased risk of large post-void residual urine volume and a lower long-term success rate in frail elderly patients were noted after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity.
膀胱内注射肉毒毒素 A 对于抗毒蕈碱药物难治性特发性逼尿肌过度活动症是有效的。然而，安全性是一个主要关注点，尤其是在老年人群中。我们研究了膀胱内注射肉毒毒素 A 治疗脆弱老年人群中难治性特发性逼尿肌过度活动症的疗效和安全性。
共有 166 例尿动力学特发性逼尿肌过度活动症患者，在使用抗毒蕈碱药物治疗 3 个月以上后仍无效，于 2004 年至 2009 年接受 1 次膀胱内 100U 肉毒毒素 A 注射。脆弱老年人定义为年龄大于 65 岁，并且有 3 项或更多特定标准，包括非故意体重减轻、自我报告的疲劳、虚弱、缓慢的步行速度和/或低体力活动。通过患者对膀胱状况的感知、排尿日记、尿动力学参数和 Kaplan-Meier 生存图估计来评估治疗结果。
我们评估了 61 例脆弱老年人患者、63 例无脆弱性的老年患者和 42 例年龄小于 65 岁的患者。膀胱内注射肉毒毒素 A 后残余尿量（大于 150ml）较大的患者在脆弱老年组中的比例明显高于其他组（分别为 60.7%、39.7%和 35.7%，p=0.018）。7 例脆弱老年患者（11.5%）发生尿潴留，4 例（6.3%）无脆弱性的老年患者和 1 例年轻患者（2.4%）发生尿潴留（p=0.203）。恢复时间在脆弱老年患者中明显较长。脆弱老年组的累积成功率明显低于其他 2 组（p=0.009）。
尽管无脆弱性的老年患者和年轻患者的安全性和疗效相似，但在膀胱内注射肉毒毒素 A 治疗难治性特发性逼尿肌过度活动症后，脆弱老年患者的残余尿量较大和长期成功率较低。
