尿道括约肌肉毒毒素 A 注射治疗尿道括约肌活动过度的疗效。

Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity.

机构信息

Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.

出版信息

Neurourol Urodyn. 2018 Nov;37(8):2651-2657. doi: 10.1002/nau.23714. Epub 2018 May 24.

DOI:10.1002/nau.23714

PMID:29797345

Abstract

PURPOSE

Urethral sphincter hyperactivity resulting in voiding dysfunction is frequently encountered. Medical treatment might not achieve a satisfactory result. OnabotlinumtoxinA urethral sphincter injection relaxes sphincter tonicity and possibly resumes efficient voiding. This study analyzed the treatment outcomes and predictor for successful onabotulinumtoxinA treatment on these patients.

METHODS

Patients with voiding dysfunction due to urethral sphincter hyperactivity and treated with injections of 100 U onabotulinumtoxinA into the urethral sphincter were retrospectively reviewed. Treatment outcomes were assessed 1 month after injection using the Global Response Assessment and were analyzed by demographic and baseline video-urodynamic characteristics.

RESULTS

Of the 95 patients included, satisfactory outcomes were reported in 58 (61.1%) patients. Treatment outcome was not related to age, gender, or voiding dysfunction subtype. Patients with satisfactory outcomes had a significantly smaller volume at first sensation of filling (P = 0.046), greater detrusor pressure (P = 0.027), higher maximum flow rate (P = 0.017), and smaller post-void residual (P = 0.006). In multivariate analysis, an open bladder neck during voiding was the only predictor for successful outcome (88% in satisfactory outcome, 12% in failure outcome, P < 0.001). Patients with non-neurogenic voiding dysfunction had a significantly longer therapeutic duration than those with neurogenic voiding dysfunction (9.55 ± 4.18 vs 7.44 ± 2.91 months, P = 0.033). Increased urinary incontinence was reported in 18 patients, including 6 with stress urinary incontinence and 12 with urgency urinary incontinence.

CONCLUSION

Subjective improvement was reported in 61.1% of patients with voiding dysfunction due to urethral sphincter hyperactivity after onabotulinumtoxinA urethral sphincter injection. An open bladder neck during voiding at baseline predicts a successful outcome.

摘要

目的

尿道括约肌活动过度导致排尿功能障碍是常见的。药物治疗可能无法取得满意的效果。OnabotulinumtoxinA 尿道括约肌注射可放松括约肌张力，可能恢复有效的排尿。本研究分析了这些患者接受 OnabotulinumtoxinA 治疗的治疗效果和成功预测因素。

方法

回顾性分析了 95 例因尿道括约肌活动过度导致排尿功能障碍并接受 100U OnabotulinumtoxinA 尿道括约肌注射治疗的患者。在注射后 1 个月使用总体反应评估来评估治疗效果，并通过人口统计学和基线视频尿动力学特征进行分析。

结果

95 例患者中，58 例（61.1%）患者报告治疗效果满意。治疗效果与年龄、性别或排尿功能障碍类型无关。治疗效果满意的患者首次感觉充盈时的尿量明显较小（P=0.046），逼尿肌压力较高（P=0.027），最大尿流率较高（P=0.017），残余尿量较小（P=0.006）。多变量分析显示，排尿时膀胱颈开放是成功治疗结果的唯一预测因素（满意结果为 88%，失败结果为 12%，P<0.001）。非神经源性排尿功能障碍患者的治疗持续时间明显长于神经源性排尿功能障碍患者（9.55±4.18 个月比 7.44±2.91 个月，P=0.033）。18 例患者报告出现尿失禁加重，其中 6 例为压力性尿失禁，12 例为急迫性尿失禁。