Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri.
Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri.
J Urol. 2014 May;191(5 Suppl):1586-91. doi: 10.1016/j.juro.2013.10.034. Epub 2014 Mar 26.
We evaluated our long-term experience with intrasphincteric botulinum toxin A injection in children with dysfunctional voiding.
From January 2006 through July 2012 we saw 2,172 neurologically normal children due to dysfunctional voiding. Of patients who presented to these visits we retrospectively identified the charts of 12 with dysfunctional voiding (8 females) in whom urotherapy and medical management failed and who underwent botulinum toxin A injection to the external urinary sphincter. Mean patient age at surgery was 10.5 years (range 4 to 19). Average followup was 45 months (range 20 to 71). Preoperatively and postoperatively all children were evaluated with history and physical examination, voiding diary, renal and pelvic ultrasound with post-void residual volume measurement and uroflowmetry.
Eight of the 12 children (67%) experienced significant improvement in voiding parameters. Before vs after treatment mean ± SD post-void residual urine volume was 115 ± 83 vs 57 ± 61 ml (p = 0.016) and the mean maximum flow rate was 11.8 ± 8.1 vs 20.4 ± 7.9 ml per second. Half of the cohort required a second injection an average of 15 months later. Three of the 4 patients who failed to show improvement had neuropsychiatric problems and 1 had evidence of bladder underactivity.
Our results demonstrate reasonable efficacy and durability of intrasphincteric botulinum toxin A injection in children with refractory dysfunctional voiding. Neuropsychiatric issues appear to negatively influence the success rate. Long-term followup is vital to identify patients in whom repeat injection may be necessary.
我们评估了我们在患有功能障碍性排尿的儿童中进行腔内肉毒毒素 A 注射的长期经验。
从 2006 年 1 月到 2012 年 7 月，我们共诊治了 2172 例神经正常的排尿功能障碍患儿。在这些就诊患儿中，我们回顾性地确定了 12 例排尿功能障碍（8 例女性）患儿的病历，这些患儿经尿动力学和药物治疗失败后，接受了外括约肌肉毒毒素 A 注射。手术时患者的平均年龄为 10.5 岁（范围 4 至 19 岁）。平均随访时间为 45 个月（范围 20 至 71 个月）。所有患儿术前和术后均进行了病史和体格检查、排尿日记、肾和盆腔超声检查，包括残余尿量测定和尿流率测定。
12 例患儿中有 8 例（67%）排尿参数显著改善。治疗前后平均±标准差残余尿量分别为 115±83ml 和 57±61ml（p=0.016），最大平均流量分别为 11.8±8.1ml/s 和 20.4±7.9ml/s。一半患儿在平均 15 个月后需要再次注射。4 例无改善患儿中有 3 例存在神经精神问题，1 例存在膀胱活动低下的证据。
我们的结果表明，腔内肉毒毒素 A 注射治疗难治性功能障碍性排尿的疗效和持久性合理。神经精神问题似乎会对成功率产生负面影响。长期随访对于确定需要重复注射的患者至关重要。
