Wang Chung-Cheng, Liao Chun-Hou, Kuo Hann-Chorng
Department of Urology, En Chu Kong Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Biomedical Engineering, Chung Yuan Christian University, Chung-Li, Taiwan.
Neurourol Urodyn. 2014 Nov;33(8):1235-9. doi: 10.1002/nau.22494. Epub 2013 Sep 23.
To investigate the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with diabetes mellitus (DM) and refractory detrusor overactivity (DO).
Forty-eight type 2 DM patients with refractory DO received intravesical 100 U onabotulinumtoxinA injection. Another 48 age-matched patients were randomly selected from a non-diabetic group as controls. Video-urodynamic studies were performed at baseline and were repeated 3 months after treatment. The treatment outcomes were graded on the basis of changes in the Patient's Perception of Bladder Condition (PPBC) and a PPBC decrease of 2 or more points was considered successful. Treatment-related adverse events including acute urinary retention, large post-voiding residual (PVR) volumes, straining to void, urinary tract infection, hematuria, and general weakness were recorded.
The mean ages of the diabetic and non-diabetic patients were 73.1 ± 8.8 and 72.0 ± 9.3 (P = 0.552), respectively. The changes of urodynamic parameters were comparable between the two groups. Similar successful results were noted at the 6-month follow-up (DM, 56% vs. non-DM, 61%, P = 0.128). Diabetic patients had a significantly greater incidence of large PVR volumes (DM, 60.4% vs. non-DM, 33.3%; P = 0.007) and general weakness (DM, 10.4% vs. non-DM, 0%; P = 0.03) after treatment. Baseline urodynamic parameters in diabetic patients did not predict the occurrence of adverse events. No major complication was noted in either group.
Intravesical onabotulinumtoxinA injection is a safe and effective treatment for DM patients with refractory DO. Patients with DM should be informed of the increased risk of large PVR before initiation of treatment.
探讨膀胱内注射A型肉毒杆菌毒素对糖尿病（DM）合并难治性逼尿肌过度活动（DO）患者的疗效和安全性。
48例2型糖尿病难治性DO患者接受膀胱内注射100 U A型肉毒杆菌毒素。另外从非糖尿病组随机选取48例年龄匹配的患者作为对照。在基线时进行视频尿动力学研究，并在治疗3个月后重复进行。治疗结果根据患者膀胱状况感知（PPBC）的变化进行分级，PPBC降低2分或更多分被认为是成功的。记录治疗相关不良事件，包括急性尿潴留、排尿后残余尿量（PVR）增多、排尿费力、尿路感染、血尿和全身乏力。
糖尿病患者和非糖尿病患者的平均年龄分别为73.1±8.8岁和72.0±9.3岁（P = 0.552）。两组尿动力学参数变化相当。在6个月随访时观察到相似的成功结果（糖尿病组为56%，非糖尿病组为61%，P = 0.128）。糖尿病患者治疗后出现大量PVR的发生率显著更高（糖尿病组为60.4%，非糖尿病组为33.3%；P = 0.007），全身乏力的发生率也更高（糖尿病组为10.4%，非糖尿病组为0%；P = 0.03）。糖尿病患者的基线尿动力学参数不能预测不良事件的发生。两组均未观察到重大并发症。
膀胱内注射A型肉毒杆菌毒素对糖尿病合并难治性DO患者是一种安全有效的治疗方法。在开始治疗前，应告知糖尿病患者出现大量PVR风险增加的情况。
