超声引导下经皮穿刺导管经尿道注射A型肉毒杆菌毒素治疗脊髓损伤男性逼尿肌外括约肌协同失调

Treatment of detrusor external sphincter dyssynergia using ultrasound-guided trocar catheter transurethral botulinum toxin a injection in men with spinal cord injury.

作者信息

Yang Wei Xin, Zhu Hong Jun, Chen Wei Guo, Zhang Da Wei, Su Min, Feng Jin Fa, Liu Chuan Dao, Cai Ping

机构信息

Department of Rehabilitation, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, People's Republic of China.

出版信息

Arch Phys Med Rehabil. 2015 Apr;96(4):614-9. doi: 10.1016/j.apmr.2014.10.003. Epub 2014 Oct 24.

DOI:10.1016/j.apmr.2014.10.003

PMID:25450132

Abstract

OBJECTIVE

To evaluate the effects of transrectal ultrasound-guided trocar catheter transurethral botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD) in men with spinal cord injury (SCI).

DESIGN

Descriptive study.

SETTING

Hospital rehabilitation department.

PARTICIPANTS

Patients (N=15; mean age, 40.5y; range, 22-64y) with suprasacral SCI with confirmed DESD determined by urodynamic study.

INTERVENTIONS

A single dose of 100U BTX-A was injected into the EUS via transrectal ultrasound-guided trocar catheter transurethral injection.

MAIN OUTCOME MEASURES

Maximal detrusor pressure, detrusor leak point pressure, maximal pressure on static urethral pressure profilometry, postvoid residual volume, and maximal flow rate.

RESULTS

After BTX-A transurethral injection, 4 (28.5%) patients showed an excellent result and 7 (46.7%) patients showed an improved result, whereas 4 (28.5%) patients experienced treatment failure. The overall success rate was 75.2%. We observed a significant decrease in static urethral pressure (P<.05) and detrusor leak point pressure after treatment (P<.05), but not in detrusor pressure. The postvoid residual volume were significantly decreased in the fourth week after treatment (P<.05).

CONCLUSIONS

Transrectal ultrasound-guided trocar catheter transurethral BTX-A injection into the EUS effectively suppresses or ameliorates DESD. A potential advantage of the method is that ultrasound guidance may not be necessary in the next injection.

摘要

目的

评估经直肠超声引导下经尿道穿刺针导管向男性脊髓损伤（SCI）患者的尿道外括约肌（EUS）注射A型肉毒毒素（BTX-A）治疗逼尿肌-外括约肌协同失调（DESD）的效果。

设计

描述性研究。

地点

医院康复科。

参与者

15例骶上脊髓损伤患者（平均年龄40.5岁；范围22 - 64岁），经尿动力学研究确诊为DESD。

干预措施

通过经直肠超声引导下经尿道穿刺针导管向EUS注射单剂量100U的BTX-A。

主要观察指标

最大逼尿肌压力、逼尿肌漏尿点压力、静态尿道压力测定的最大压力、排尿后残余尿量和最大尿流率。

结果

经尿道注射BTX-A后，4例（28.5%）患者效果极佳，7例（46.7%）患者有所改善，而4例（28.5%）患者治疗失败。总体成功率为75.2%。我们观察到治疗后静态尿道压力（P<0.05）和逼尿肌漏尿点压力显著降低（P<0.05），但逼尿肌压力未降低。治疗后第4周排尿后残余尿量显著减少（P<0.05）。