Bayrak Ömer, Sadioğlu Erkan, Onur Rahmi
Department of Urology, Gaziantep University, Gaziantep, Turkey.
Department of Urology, Marmara University, Istanbul, Turkey.
Turk J Urol. 2015 Dec;41(4):221-7. doi: 10.5152/tud.2015.25307.
Neurogenic detrusor overactivity (NDO) is a disorder that can cause high intravesical pressure, decreased capacity, decreased bladder compliance, and upper urinary system damage. The current treatment options for NDO are established on the basis of agents that block parasympathetic innervation of the detrusor and inhibit involuntary bladder contractions. Several side effects, such as dryness of mouth, constipation, dyspepsia, changes in visual accommodation, somnolence, and being unable to obtain consistently favorable results, caused by anticholinergic agents, which are frequently used for this purpose, decrease the patient's compliance to treatment. Procedures such as neuromodulation, auto-augmentation, and enterocystoplasty are surgical options, and they could be used as the last alternative. Thus, botulinum toxin (BTX) injections to the detrusor have been commonly performed in recent years and lead to satisfactory results. The mechanism of action of BTX in NDO is based on the principal of smooth muscle relaxation in the bladder by the transient inhibition of neuromuscular nerve signals. The aim is to decrease acetylcholine secretion by blocking presynaptic vesicles in the neuromuscular junction. When studies were evaluated, it was observed that BTX injections to the detrusor muscle are a necessary and effective option in patients with incontinence caused by NDO. This treatment option could be indicated in situations where anticholinergic agents are not effective or could not be tolerated, and it could be a valuable alternative to major surgical treatments. In this review, we evaluated the effectiveness and reliability of BTX in patients with NDO.
神经源性逼尿肌过度活动（NDO）是一种可导致膀胱内压升高、容量减少、膀胱顺应性降低及上尿路损害的疾病。目前NDO的治疗方案是基于阻断逼尿肌副交感神经支配并抑制膀胱不自主收缩的药物制定的。常用于此目的的抗胆碱能药物会引起口干、便秘、消化不良、视觉调节改变、嗜睡等多种副作用，且无法持续获得良好效果，从而降低了患者的治疗依从性。神经调节、自体膀胱扩大术和肠膀胱扩大术等手术是治疗选择，可作为最后的备选方案。因此，近年来向逼尿肌注射肉毒杆菌毒素（BTX）的操作较为常见且效果令人满意。BTX在NDO中的作用机制基于通过短暂抑制神经肌肉神经信号使膀胱平滑肌松弛的原理。其目的是通过阻断神经肌肉接头处的突触前囊泡来减少乙酰胆碱的分泌。在对相关研究进行评估时发现，向逼尿肌注射BTX对于NDO所致尿失禁患者是一种必要且有效的选择。在抗胆碱能药物无效或无法耐受的情况下可采用这种治疗方法，它可能是主要手术治疗的一种有价值的替代方案。在本综述中，我们评估了BTX对NDO患者的有效性和可靠性。
