Kask M, Rintala R, Taskinen S
Children's Hospital, University of Helsinki, Helsinki, Finland.
Children's Hospital, University of Helsinki, Helsinki, Finland.
J Pediatr Urol. 2014 Apr;10(2):280-3. doi: 10.1016/j.jpurol.2013.09.004. Epub 2013 Sep 30.
To evaluate clinical and urodynamic efficiency of onabotulinumtoxinA (Botox) treatment in pediatric patients with urinary incontinence due to neurogenic overactive bladder.
Seventeen patients aged from 6 to 17 years (median 11 years) were treated with Botox injections. Clinical response to incontinence, duration of the response, and urodynamic results before and 1-3 months after treatment were evaluated.
Mean incontinence frequency decreased significantly (p = 0.036); six of 17 patients had >90% reduction, and a further three patients had a 50-90% reduction in incontinence episodes. Median duration of the response was 15 months (range 3-42 months). Mean bladder volume changed from 380 ± 148 ml to 453 ± 147 (p = 0.078), maximal detrusor pressure decreased from 45 ± 31 cmH2O to 32 ± 21 cmH2O (p = 0.030), and the number of patients with detrusor contractions during filling decreased from 12 to three (p = 0.005) after the treatment. The patients with poor bladder compliance had either no response or a short duration of response. At follow-up eight patients had undergone bladder augmentation because of persistent incontinence.
About one third of pediatric patients with neurogenic bladder had a good response to Botox treatment. In many patients, the clinical response was longer than expected. The patients who initially had poor bladder compliance had a poor response to the treatment.
评估注射用A型肉毒毒素（保妥适）治疗小儿神经源性膀胱过度活动症所致尿失禁的临床及尿动力学疗效。
对17例年龄在6至17岁（中位年龄11岁）的患者进行了保妥适注射治疗。评估了对尿失禁的临床反应、反应持续时间以及治疗前和治疗后1至3个月的尿动力学结果。
平均尿失禁频率显著降低（p = 0.036）；17例患者中有6例减少超过90%，另有3例患者尿失禁发作减少50%至90%。反应的中位持续时间为15个月（范围3至42个月）。平均膀胱容量从380±148 ml变为453±147 ml（p = 0.078），最大逼尿肌压力从45±31 cmH₂O降至32±21 cmH₂O（p = 0.030），治疗后充盈期出现逼尿肌收缩的患者数量从12例降至3例（p = 0.005）。膀胱顺应性差的患者要么无反应，要么反应持续时间短。随访时，8例患者因持续性尿失禁接受了膀胱扩大术。
约三分之一的小儿神经源性膀胱患者对保妥适治疗反应良好。在许多患者中，临床反应比预期的要长。最初膀胱顺应性差的患者对治疗反应不佳。
