Peyronnet B, Sanson S, Amarenco G, Castel-Lacanal E, Chartier-Kastler E, Charvier K, Damphousse M, Denys P, de Seze M, Egon G, Even A, Forin V, Karsenty G, Kerdraon J, le Normand L, Loche C-M, Manunta A, Mouracade P, Phe V, Previnaire J-G, Ruffion A, Saussine C, Schurch B, Game X
Service d'urologie, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Toulouse, France.
Prog Urol. 2015 Dec;25(17):1219-24. doi: 10.1016/j.purol.2015.07.006. Epub 2015 Aug 28.
There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin.
A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions.
Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40 cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%).
This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment.
目前尚无关于膀胱内注射肉毒杆菌毒素难治性神经源性逼尿肌过度活动（NDO）管理的指南。本研究的主要目的是找到膀胱内注射肉毒杆菌毒素治疗NDO失败的共识定义。次要目的是报告肉毒杆菌毒素难治性NDO管理的当前趋势。
基于现有文献数据创建了一项调查，并通过电子邮件发送给法语神经泌尿学研究小组（GENULF）和法国泌尿外科学会（AFU）神经泌尿学委员会的所有专家。未回复第一封电子邮件的专家又被联系了两次。调查的主要结果以数字和比例的形式呈现。
在联系的42位专家中，21位回复了调查。19名参与者认为失败的定义应是临床和尿动力学标准的结合。在尿动力学标准中，最大逼尿肌压力>40 cm H2O的持续存在得到了专家的最多支持（18/21，85%）。根据绝大多数参与者（19/21，90.5%）的意见，注射对尿失禁的影响应纳入失败的定义。关于管理，大多数专家认为，在首次膀胱内注射200 U保妥适（Botox®）失败的情况下，一线治疗应是重复注射更高剂量（300 U）的保妥适（Botox®）（15/20，75%），无论是否存在上尿路损伤的尿动力学危险因素（16/20，80%）。
这项工作首次概述了膀胱内注射肉毒杆菌毒素治疗NDO失败的定义。对于90.5%的参与专家来说，失败的定义应是临床和尿动力学的，并且大多数参与者（75%）认为，在首次注射200 U保妥适（Botox®）失败的情况下，重复注射300 U保妥适（Botox®）应是一线治疗。
