Henriet B, Roumeguère T
Rev Med Brux. 2015 Jan-Feb;36(1):29-37.
OAB is common with a potential negative impact on quality of life. Anticholinergics and β3-mimetics are the first-line medical treatment. This treatment meets only 50% of patients given a lack of efficacy and adverse effects. Used in the treatment of neurogenic overactive bladder, botulinum toxin is now evaluated for the treatment of refractory non-neurogenic overactive bladder. The objective of this work is to review the literature data concerning the efficacy and safety of intradetrusor botulinum toxin injections to treat refractory idiopathic overactive bladder.
A systematic literature review was conducted to identify articles published between May 1988 and April 2013 in Medline for the treatment of refractory idiopathic overactive bladder with botulinum toxin.
37 studies with original samples were selected including 8 randomized controlled trials against placebo. The effectiveness of intra- detrusor injections is demonstrated to reduce the frequency, urgency, nighttime urination, incontinence episodes and to improve bladder capacity and quality of life. The most common side effects are incomplete bladder emptying, intermittent catheterization and increased risk of urinary tract infection. A dose of 100 to 150 U of onabotulinumtoxinA allows the best compromise between efficiency and tolerance. Duration of the effects varies between 3 to 12 months and repeating the injections did not seem to affect the efficiency. Injections including the trigone zone do not cause vesicoureteral reflux. The absence of detrusor hyperactivity does not alter the clinical response.
The detrusor injections of botulinum toxin can be considered as an effective second-line treatment for refractory non-neurogenic overactive bladder. Information on intermittent catheterization risk must be provided. The very long-term effectiveness and the absence of urothelium alterations are still outstanding issues.
膀胱过度活动症很常见，对生活质量有潜在负面影响。抗胆碱能药物和β3 激动剂是一线药物治疗方法。但由于疗效欠佳和不良反应，这种治疗仅适用于 50%的患者。肉毒杆菌毒素用于治疗神经源性膀胱过度活动症，目前正被评估用于治疗难治性非神经源性膀胱过度活动症。这项工作的目的是回顾有关膀胱内注射肉毒杆菌毒素治疗难治性特发性膀胱过度活动症的疗效和安全性的文献数据。
进行了一项系统的文献综述，以确定 1988 年 5 月至 2013 年 4 月期间发表在 Medline 上的用肉毒杆菌毒素治疗难治性特发性膀胱过度活动症的文章。
选择了 37 项有原始样本的研究，包括 8 项针对安慰剂的随机对照试验。膀胱内注射的有效性已得到证实，可减少尿频、尿急、夜尿、尿失禁发作次数，并改善膀胱容量和生活质量。最常见的副作用是膀胱排空不全、间歇性导尿和尿路感染风险增加。100 至 150 单位的A型肉毒杆菌毒素剂量能在疗效和耐受性之间达到最佳平衡。效果持续时间在 3 至 12 个月之间，重复注射似乎不影响疗效。包括三角区在内的注射不会引起膀胱输尿管反流。无逼尿肌过度活动并不改变临床反应。
膀胱内注射肉毒杆菌毒素可被视为治疗难治性非神经源性膀胱过度活动症的一种有效的二线治疗方法。必须提供有关间歇性导尿风险的信息。长期疗效和无尿路上皮改变仍是突出问题。
