Osborn David James, Kaufman Melissa R, Mock Stephen, Guan Michael J, Dmochowski Roger R, Reynolds W Stuart
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
Neurourol Urodyn. 2015 Sep;34(7):675-8. doi: 10.1002/nau.22642. Epub 2014 Jun 29.
The purpose of this study was to find the rate of urinary retention in clinical practice after treatment with onabotulinumtoxinA (BTN/A) for refractory overactive bladder (OAB) symptoms and determine factors that predict this outcome.
This is a retrospective study of BTN/A for treatment of non-neurogenic, refractory OAB symptoms. Patients were analyzed with respect to their first and second BTN/A injections. The primary outcome measure was postoperative urinary retention. Statistical significance was assessed with multivariate logistic regression.
Based on inclusion and exclusion criteria, the study population was 160. Mean age was 64 ± 13.2 years and 24% of the patients were men. The rate of urinary retention was 35% (n = 56). For the first BTN/A treatment, multivariate analysis revealed that preoperative PVR (post-void residual volume) (OR 1.27, 95% CI 1.13-1.43, P < 0.001) and preoperative bladder capacity (OR 1.05, 95% CI 1.01-1.08, P = 0.005) were associated with postoperative urinary retention. In patients with a preoperative PVR of ≥100 ml, 94% (n = 17) went into urinary retention. For those who underwent a second BTN/A treatment, preoperative PVR, BTN/A units injected and retention after the first BTN/A were associated with an increased rate of postoperative retention.
Increased preoperative PVR was associated with urinary retention. The retention rate is higher than that reported in recent clinical trials. The inclusion of patients with a preoperative PVR ≥100 ml and a lower threshold to initiate clean intermittent catheterization contributed to this high rate of retention.
本研究旨在确定在临床实践中，使用A型肉毒杆菌毒素（BTN/A）治疗难治性膀胱过度活动症（OAB）症状后的尿潴留发生率，并确定预测该结果的因素。
这是一项关于BTN/A治疗非神经源性难治性OAB症状的回顾性研究。对患者的首次和第二次BTN/A注射进行分析。主要结局指标为术后尿潴留。采用多因素逻辑回归评估统计学意义。
根据纳入和排除标准，研究人群为160例。平均年龄为64±13.2岁，24%的患者为男性。尿潴留发生率为35%（n = 56）。对于首次BTN/A治疗，多因素分析显示术前残余尿量（PVR）（比值比[OR]1.27，95%置信区间[CI]1.13 - 1.43，P < 0.001）和术前膀胱容量（OR 1.05，95% CI 1.01 - 1.08，P = 0.005）与术后尿潴留相关。术前PVR≥100 ml的患者中，94%（n = 17）发生尿潴留。对于接受第二次BTN/A治疗的患者，术前PVR、注射的BTN/A单位剂量以及首次BTN/A治疗后的潴留情况与术后潴留发生率增加相关。
术前PVR增加与尿潴留相关。该潴留率高于近期临床试验报道的水平。纳入术前PVR≥100 ml的患者以及启动清洁间歇性导尿的较低阈值导致了如此高的潴留率。
