Rahnama'i Mohammad S, Marcelissen Tom A T, Brierley Beverley, Schurch Brigitte, de Vries Peter
Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands.
Maastricht University, Maastricht, The Netherlands.
Neurourol Urodyn. 2017 Sep;36(7):1855-1859. doi: 10.1002/nau.23196. Epub 2017 Jan 13.
Intravesical injections with botulinum toxin A (BoNT-A) is an established treatment for patients with overactive bladder (OAB) symptoms. However, most studies have evaluated the efficacy of this treatment in women and report short-term results. In this study, we evaluated the long-term compliance of BoNT-A in a heterogeneous group of male patients.
This is a retrospective, single-centre study. We evaluated all male patients who have been treated with BoNT-A from 2004 until 2010 in a large teaching hospital. Patients received 100-300 U of onabotulinum toxin-A in 20 intravescial injections. Some patients received dose adjustment with repeated injections.
In total, 88 male patients were included. The mean follow-up was almost 6 years (69 months). Of all patients, 22 (25%) continued BoNT-A treatment at last follow-up (success). Of the patients who discontinued treatment, 35 had insufficient effect and 27 had tolerability issues (eg, urinary retention, self-catheterisation, voiding LUTS). Four patients abandoned treatment due to other reasons that were not related to BoNT-A. Of all patients, 24% had to use intermittent catheterisation (de novo) or indwelling catheters at some point during the follow-up.
In this real-life, heterogeneous cohort of men, the long-term compliance with BoNT-A was 25%. Patients with neurogenic OAB symptoms appear to have the best results in our study with 36% of patients who were still on active treatment during last follow-up. Intravesical BoNT-A can be an effective treatment for men with OAB symptoms. In our study, only 25% of patients continued treatment during long-term follow-up. Larger, prospective trials are needed to confirm these results.
膀胱内注射A型肉毒杆菌毒素（BoNT-A）是治疗膀胱过度活动症（OAB）患者的一种既定疗法。然而，大多数研究评估了该疗法对女性患者的疗效，并报告了短期结果。在本研究中，我们评估了BoNT-A在一组异质性男性患者中的长期依从性。
这是一项回顾性单中心研究。我们评估了2004年至2010年期间在一家大型教学医院接受BoNT-A治疗的所有男性患者。患者接受了20次膀胱内注射，剂量为100 - 300单位的A型肉毒杆菌毒素。一些患者通过重复注射进行剂量调整。
总共纳入了88名男性患者。平均随访时间近6年（69个月）。在所有患者中，22名（25%）在最后一次随访时仍继续接受BoNT-A治疗（成功）。在停止治疗的患者中，35名效果不佳，27名存在耐受性问题（如尿潴留、自行导尿、排尿下尿路症状）。4名患者因与BoNT-A无关的其他原因放弃治疗。在所有患者中，24%在随访期间的某个时间点不得不使用间歇性导尿（新发）或留置导尿管。
在这个现实生活中的异质性男性队列中，BoNT-A的长期依从性为25%。在我们的研究中，患有神经源性OAB症状的患者似乎效果最佳，36%的患者在最后一次随访时仍在接受积极治疗。膀胱内注射BoNT-A对患有OAB症状的男性可能是一种有效的治疗方法。在我们的研究中，只有25%的患者在长期随访期间继续治疗。需要更大规模的前瞻性试验来证实这些结果。
