Lombardi Giuseppe, Musco Stefania, Bacci Giovanni, Celso Maria, Bellio Valerio, Del Popolo Giulio
Department of Neuro-Urology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
Department of Biology, Universita Degli Studi di Firenze, Toscana, Italy.
Int Braz J Urol. 2017 Jul-Aug;43(4):721-729. doi: 10.1590/S1677-5538.IBJU.2016.0584.
To assess the response in spinal cord injured patients alternatively treated with different types and dosages of Botulinum neurotoxin type A (BoNT/A) over 15 years.
Patients who underwent first BoNT/A from 1999-2001 and practiced intermittent catheterization were included. Baseline 3-day bladder diary (BD) and urodynamics were collected. BoNT/A failure was defined when patients asked for re-injection ≤ 3 months post-treatment. Criteria for re-injection was at least one daily episode of urinary incontinence at BD. Before re-injection, patients were asked if they had reached 6 months of dryness without antimuscarinics (YES response).
Overall, 32/60 (53.4%) "No failure" (NF) group; 16 (26.6%) "occasional failure" (OF) and 12 (20%) "consecutive failure" (CF) were included. A total of 822 BoNT/A infiltrations were performed. The mean interval from previous injection to treatment re-scheduling was 8 months. No significant differences between treatments were found within the three groups (p>0.05). The percentage of YES responses increased from 19% (AboBoNT/A 500IU) to 29 % (OnaBoNT/A 300IU) in NF, and from 18% (AboBoNT/A 500IU) to 25% (OnaBoNT/A 300IU) for OF. Five NF cases (15.6%) maintained 6 months of dryness after each injection. Among the baseline variables, only low compliance (< 20mL/cmH2O) was found as predictor for failure (p=0.006).
Long term BoNT/A for NDO did not increase failures, independent of the types of treatments and switching. Definition of failure and other criteria for continuing repetitive BoNT/A treatment is mandatory. CF was predictable for no response in earlier follow-up.
评估在15年期间接受不同类型和剂量A型肉毒杆菌毒素（BoNT/A）交替治疗的脊髓损伤患者的反应。
纳入1999年至2001年首次接受BoNT/A治疗并采用间歇性导尿的患者。收集基线3天膀胱日记（BD）和尿动力学数据。当患者在治疗后≤3个月要求再次注射时，定义为BoNT/A治疗失败。再次注射的标准是BD中至少有一次每日尿失禁发作。在再次注射前，询问患者是否在没有抗毒蕈碱药物的情况下达到了6个月的干燥期（回答“是”）。
总体而言，纳入了32/60（53.4%）的“无失败”（NF）组；16例（26.6%）“偶尔失败”（OF）和12例（20%）“连续失败”（CF）。共进行了822次BoNT/A注射。从上一次注射到重新安排治疗的平均间隔时间为8个月。三组之间的治疗效果无显著差异（p>0.05）。NF组中回答“是”的比例从19%（AboBoNT/A 500IU）增加到29%（OnaBoNT/A 300IU），OF组从18%（AboBoNT/A 500IU）增加到25%（OnaBoNT/A 300IU）。5例NF患者（15.6%）每次注射后保持6个月的干燥期。在基线变量中，仅发现低顺应性（<20mL/cmH2O）是失败的预测因素（p=0.006）。
长期使用BoNT/A治疗神经源性膀胱过度活动症不会增加失败率，与治疗类型和转换无关。必须明确失败的定义以及继续重复使用BoNT/A治疗的其他标准。在早期随访中，CF组对治疗无反应是可预测的。
