El-Azab Ahmed S, Moeen Ahmed M
Section of Female Urology and Neurourology, Department of Urology, Asyut University Hospital, Asyut University, Asyut, Egypt.
Arab J Urol. 2013 Dec;11(4):344-9. doi: 10.1016/j.aju.2013.07.003. Epub 2013 Aug 12.
To assess the satisfaction of patients with refractory idiopathic overactive bladder (OAB) with two treatment methods, onabotulinumtoxinA (oBTX) and augmentation ileocystoplasty (AC).
This prospective study included patients with refractory idiopathic OAB for >6 months and a urodynamic diagnosis of OAB. Oral pharmacotherapy had failed in all patients. Patients with any suspected neurological disorder were excluded. Before the procedure, patients completed the Urogenital Distress Inventory (UDI-6) and modified Incontinence Impact Questionnaire (IIQ-7), a neurological evaluation, a urodynamic study and their postvoid residual urine volume was measured. Patients were assigned to receive oBTX or AC, depending on patient's preference. Follow-up visits were at 6 weeks and 3 and 6 months after the procedure. The OAB Satisfaction questionnaire (OAB-SAT-q) was used to assess satisfaction after the procedure.
In all, 31 patients with refractory OAB were included, 16 in the oBTX group and 15 in the AC group. There was no significant difference between the groups in mean age, baseline OAB symptoms and urodynamic values. There were significant improvements in urinary symptoms (UDI-6) and quality of life (IIQ-7) after both procedures (except in the domain enquiring about difficulty, which significantly worsened after AC). Of the 16 patients, 15/16 and seven of 15 were completely dry after AC and oBTX, respectively. The overall and individual scores of the OAB-SAT-q were significantly higher among patients treated with AC than with oBTX. The incidence of the de novo need to use clean intermittent catheterisation after oBTX and AC was two of 16 and four of 15, respectively.
Both procedures are effective in improving the symptoms of OAB and of quality of life, but patients were more satisfied with AC than oBTX therapy.
评估难治性特发性膀胱过度活动症（OAB）患者对两种治疗方法——A型肉毒毒素（oBTX）和回肠膀胱扩大术（AC）的满意度。
这项前瞻性研究纳入了难治性特发性OAB病程超过6个月且经尿动力学诊断为OAB的患者。所有患者口服药物治疗均失败。排除任何疑似神经系统疾病的患者。在手术前，患者完成泌尿生殖系统困扰量表（UDI-6）和改良的尿失禁影响问卷（IIQ-7）、神经学评估、尿动力学研究并测量其排尿后残余尿量。根据患者的偏好，将患者分配接受oBTX或AC治疗。术后6周、3个月和6个月进行随访。使用OAB满意度问卷（OAB-SAT-q）评估术后满意度。
总共纳入了31例难治性OAB患者，oBTX组16例，AC组15例。两组在平均年龄、基线OAB症状和尿动力学值方面无显著差异。两种手术后，泌尿症状（UDI-6）和生活质量（IIQ-7）均有显著改善（AC术后询问困难程度的领域显著恶化除外）。16例患者中，AC术后15/16例完全无尿，oBTX术后15例中有7例完全无尿。AC治疗的患者中，OAB-SAT-q的总体和个体评分显著高于oBTX治疗的患者。oBTX和AC术后新发需要使用清洁间歇性导尿的发生率分别为16例中的2例和15例中的4例。
两种手术在改善OAB症状和生活质量方面均有效，但患者对AC治疗的满意度高于oBTX治疗。
