Knuepfer Stephanie, Juenemann Klaus-Peter
Spinal Cord Injury Center & Research, University Zürich, Balgrist University Hospital, Zürich, Forchstrasse 340, 8008 CH, Switzerland.
University of Kiel, Kiel, Germany University Hospital of Urology Germany.
Ther Adv Urol. 2014 Feb;6(1):34-42. doi: 10.1177/1756287213510962.
Control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous system. Neurogenic lower urinary tract dysfunction (LUTD) is a widespread chronic illness that impairs millions of people worldwide. Neurogenic LUTD has a major impact on quality of life, affecting emotional, social, sexual, occupational and physical aspects of daily life, and in addition to the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system. First-line treatment for neurogenic LUTD includes antimuscarinics and some form of catheterization, preferably intermittent self-catheterization. However, the treatment effect is often unsatisfactory, so that other options have to be considered. Moreover, neurogenic LUTD is a challenge because all available treatment modalities (i.e. conservative, minimally invasive and invasive therapies) may fail. In recent years, botulinum neurotoxin type A (BoNT/A) treatment has been shown to be an effective pharmacological therapy option in patients refractory to antimuscarinic and neurogenic detrusor overactivity (NDO). Several studies have shown that BoNT/A injection significantly reduces detrusor muscle overactivity. Also BoNT/A treatment of NDO has revealed a significant improvement of lower urinary tract function with regard to reduced urinary incontinence, reduced detrusor pressure, increased bladder capacity and improved quality of life in NDO.
下尿路控制是一个复杂的多水平过程，涉及外周和中枢神经系统。神经源性下尿路功能障碍（LUTD）是一种广泛存在的慢性疾病，影响着全球数百万人。神经源性LUTD对生活质量有重大影响，涉及日常生活的情感、社交、性、职业和身体方面，除了给患者带来衰弱的表现外，还给每个医疗系统带来了巨大的经济负担。神经源性LUTD的一线治疗包括抗毒蕈碱药物和某种形式的导尿，最好是间歇性自我导尿。然而，治疗效果往往不尽人意，因此不得不考虑其他选择。此外，神经源性LUTD是一项挑战，因为所有可用的治疗方式（即保守治疗、微创治疗和侵入性治疗）都可能失败。近年来，A型肉毒杆菌神经毒素（BoNT/A）治疗已被证明是对抗毒蕈碱药物难治的神经源性逼尿肌过度活动（NDO）患者的一种有效的药物治疗选择。多项研究表明，BoNT/A注射可显著降低逼尿肌过度活动。此外，BoNT/A治疗NDO在减少尿失禁、降低逼尿肌压力、增加膀胱容量和改善NDO患者生活质量方面，已显示出下尿路功能的显著改善。
