Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London, ON, Canada.
Arch Phys Med Rehabil. 2013 Aug;94(8):1473-81. doi: 10.1016/j.apmr.2013.04.011. Epub 2013 Apr 28.
To examine the effectiveness of botulinum toxin type A (BTX-A) on neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI).
MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to June 2012.
Trials examining the use of BTX-A injections into the detrusor wall in the treatment of NDO after SCI were included if (1) ≥ 50% of study sample comprised subjects post-SCI; (2) outcomes of interest were assessed before and after treatment with a single injection of BTX-A; and (3) the sample size was ≥ 3.
A standardized mean difference ± SE (95% confidence interval) was calculated for at least 1 of the following outcomes in every study: postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, catheterization frequency, and maximum flow rate. Results from all studies were then pooled using a random-effects model. Treatment effect sizes were interpreted as small, >0.2; moderate, >0.5; or large, >0.8.
Fourteen studies representing data from 734 subjects were included. After BTX-A injection, large treatment effects were observed in postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, and catheterization frequency (P<.01). Rate of incontinence episodes was reduced from 23% to 1.31% after BTX-A treatment. No significant decrease in max flow rate was observed (P=.403).
Results of the meta-analysis indicate BTX-A is effective in treating NDO after SCI. The use of BTX-A was associated with a decrease in incontinence episodes, catheter use, and bladder pressures.
研究 A 型肉毒毒素（BTX-A）治疗脊髓损伤（SCI）后神经原性逼尿肌过度活动（NDO）的疗效。
检索 1980 年至 2012 年 6 月发表的所有相关文章，使用 MEDLINE、CINAHL、EMBASE 和 PsycINFO 数据库。
纳入研究将 BTX-A 注射到逼尿肌壁中治疗 SCI 后 NDO，需满足以下条件：（1）研究样本中≥50%为 SCI 后患者；（2）采用 BTX-A 单次注射治疗前后评估了感兴趣的结果；（3）样本量≥3。
每个研究至少有 1 项以下结果评估标准化均数差±SE（95%置信区间）：残余尿量、反射性膀胱容积、膀胱容量、膀胱顺应性、导尿频率和最大尿流率。然后采用随机效应模型汇总所有研究的结果。将治疗效果大小解释为小（>0.2）、中（>0.5）或大（>0.8）。
纳入的 14 项研究代表了 734 例患者的数据。BTX-A 注射后，残余尿量、反射性膀胱容积、膀胱容量、膀胱顺应性和导尿频率的治疗效果显著（P<.01）。BTX-A 治疗后尿失禁发作率从 23%降至 1.31%。最大尿流率未见明显下降（P=.403）。
荟萃分析结果表明 BTX-A 治疗 SCI 后 NDO 有效。BTX-A 的使用与减少尿失禁发作、导尿使用和膀胱压相关。
