A型肉毒杆菌毒素注射尿道括约肌对自我间歇性导尿困难患者的疗效

[Efficacy of botulinum toxin A injections in the urethral sphincter in patients with difficulties to perform self-intermittent catherization].

作者信息

Honore T, Le Breton F, Turmel N, Bignani B, Chesnel C, Charlanes A, Amarenco G

机构信息

Service MPR, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.

GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France.

出版信息

Prog Urol. 2018 Jun;28(7):370-376. doi: 10.1016/j.purol.2018.04.001.

DOI:10.1016/j.purol.2018.04.001

PMID:29776876

Abstract

PURPOSE

To evaluate safety and efficacy of botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization.

METHODS

In this prospective study, 12 patients suffering from upper motor neuron diseases (8 multiple sclerosis, 2 myelitis, 1 brain injury, 1 multi system atrophy) and with difficulties to perform self-intermittent catherization, defined by a ICDQ score>1 (Intermittent Catheterization Difficulty Questionnaire) have had injections of 100U BOTOX under EMG guidance in the urethral striated sphincter, for a total of 15 injections. Evaluations consisted of two questionnaires (ICDQ and PGI-A, Patient Global Improvement) 30 days after the injection.

RESULTS

30 days after the injection, ICDQ was improved with a mean decrease of the total score of 7.8 (SD=5.9, P<0,001). In the same manner, all the patients were improved with a mean PGI-A score of 2.3. In 73.3 % of cases, the PGI-A score was equal to 2 (improvement=much better), and in 20 % it was equal to 3 (improvement=a little better).

CONCLUSIONS

Botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization seem to safe and effective.

LEVEL OF EVIDENCE

摘要

目的

评估A型肉毒杆菌毒素注射于尿道横纹括约肌对自我间歇性导尿困难患者的安全性和有效性。

方法

在这项前瞻性研究中，12例患有上运动神经元疾病（8例多发性硬化症、2例脊髓炎、1例脑损伤、1例多系统萎缩）且自我间歇性导尿困难（由ICDQ评分>1定义，间歇性导尿困难问卷）的患者在肌电图引导下于尿道横纹括约肌注射100U保妥适，共注射15次。评估包括注射后30天的两份问卷（ICDQ和PGI-A，患者整体改善情况）。