Collins Linda, Sathiananthamoorthy Sanchutha, Fader Mandy, Malone-Lee James
Research Department of Clinical Physiology, Division of Medicine, University College London, Middlesex University, London, UK.
School of Health and Education, Middlesex University, WG11 Williams Building, The Burroughs, Hendon, London, NW4 4BT, UK.
Int Urogynecol J. 2017 Sep;28(9):1351-1356. doi: 10.1007/s00192-017-3271-1. Epub 2017 Jan 23.
Botulinum toxin has become a widely adopted treatment for patients with recalcitrant overactive bladder (OAB) symptoms. Some recommend clean intermittent self-catheterisation (CISC) if a postvoid residual (PVR) >200 ml posttreatment, but there is no evidence for this recommendation. The aim of this study was to identify whether abstinence from CISC as a routine strategy for patients with a PVR following intradetrusor botulinum toxin injections is associated with any measurable adversity.
This was a cohort observation study. Patients with lower urinary tract symptoms (LUTS) attending a medical urology centre were observed before and after botulinum toxin treatment. Intradetrusal botulinum toxin injections were administered in the day-treatment centre at a medical urology centre in London, UK. Patients were reviewed at follow-up consultations to measure PVR.
Of the 240 patients studied, 215 were women and 25 were men, of whom, 196 (82%) received botulinum toxin injections and were not managed with CISC; 18% were using CISC prior to injections and continued. None of the 196 patients developed acute retention or significant voiding symptoms.
Our study indicates that routine administration of CISC based on an arbitrary PVR volume is unlikely to confer benefit. In order to avoid patients being deterred from botulinum treatment, we recommend that CISC be reserved for those who have troublesome voiding symptoms as well as a raised PVR. It is unlikely that CISC, initiated on the basis of an arbitrary PVR volume, would benefit the patient.
肉毒杆菌毒素已成为治疗顽固性膀胱过度活动症（OAB）患者的一种广泛应用的方法。一些人建议，如果治疗后残余尿量（PVR）>200 ml，则进行清洁间歇性自我导尿（CISC），但这一建议并无证据支持。本研究的目的是确定，对于膀胱内注射肉毒杆菌毒素后有残余尿量的患者，不进行CISC这一常规策略是否会带来任何可测量的不良影响。
这是一项队列观察研究。对一家医学泌尿外科中心的下尿路症状（LUTS）患者在肉毒杆菌毒素治疗前后进行观察。在英国伦敦一家医学泌尿外科中心的日间治疗中心进行膀胱内肉毒杆菌毒素注射。在随访咨询时对患者进行复查以测量残余尿量。
在研究的240例患者中，215例为女性，25例为男性，其中196例（82%）接受了肉毒杆菌毒素注射且未进行CISC治疗；18%的患者在注射前使用CISC并在注射后继续使用。196例患者中无一例出现急性尿潴留或明显的排尿症状。
我们的研究表明，基于任意残余尿量进行CISC的常规治疗不太可能带来益处。为避免患者因肉毒杆菌毒素治疗而望而却步，我们建议CISC仅用于那些有排尿困难症状且残余尿量增加的患者。基于任意残余尿量开始进行CISC不太可能使患者受益。
