Peyronnet Benoit, Gamé Xavier, Vurture Gregory, Nitti Victor W, Brucker Benjamin M
Department of Urology, University of Rennes Rennes, France.
Department of Urology, New York University New York, NY.
Rev Urol. 2018;20(2):84-93. doi: 10.3903/riu0792.
The use of botulinum toxin A (BTX-A) has revolutionized the treatment of neurogenic lower urinary tract dysfunction (NLUTD) over the past three decades. Initially, it was used as a sphincteric injection for detrusor sphincter dyssynergia but now is used mostly as intradetrusor injection to treat neurogenic detrusor overactivity (NDO). Its use is supported by high-level-of-evidence studies and it has become the gold-standard treatment for patients with NDO refractory to anticholinergics. Several novelties have emerged in the use of BTX-A in neurourology over the past few years. Although onabotulinumtoxinA (BOTOX, Allergan, Inc., Irvine, CA) remains the only BTX-A for which use is supported by large, multicenter, randomized, controlled trials (RCT), and is therefore the only one to be licensed in the United States and Europe, a second BTX-A, abobotulinumtoxinA (Dysport, Ipsen Biopharmaceuticals, Basking Ridge, NJ), is also supported by high-level-of-evidence studies. Other innovations in the use of BTX-A in neurourology during the past few years include the BTX switch (from abobotulinumtoxinA to onabotulinumtoxinA or the opposite) as a rescue option for primary or secondary failures of intradetrusor BTX-A injection and refinements in intradetrusor injection techniques (number of injection sites, injection into the trigone). There is also a growing interest in long-term failure of BTX-A for NDO and their management, and a possible new indication for urethral sphincter injections.
在过去三十年里，肉毒杆菌毒素A（BTX-A）的使用彻底改变了神经源性下尿路功能障碍（NLUTD）的治疗方式。最初，它被用作治疗逼尿肌括约肌协同失调的括约肌注射药物，但现在主要用作膀胱逼尿肌内注射来治疗神经源性逼尿肌过度活动（NDO）。其应用得到了高证据水平研究的支持，并且已成为抗胆碱能药物治疗无效的NDO患者的金标准治疗方法。在过去几年中，BTX-A在神经泌尿学中的应用出现了一些新进展。尽管注射用A型肉毒毒素（保妥适，艾尔建公司，加利福尼亚州欧文市）仍然是唯一一种得到大型、多中心、随机、对照试验（RCT）支持其使用的BTX-A，因此也是在美国和欧洲唯一获得许可的一种，但另一种BTX-A，即A型肉毒杆菌毒素（达力士，益普生生物制药公司，新泽西州巴斯金里奇），也得到了高证据水平研究的支持。过去几年中，BTX-A在神经泌尿学应用中的其他创新包括BTX转换（从A型肉毒杆菌毒素转换为注射用A型肉毒毒素或相反），作为膀胱逼尿肌内BTX-A注射原发性或继发性失败的挽救选择，以及膀胱逼尿肌内注射技术的改进（注射部位数量、三角区注射）。人们对BTX-A治疗NDO的长期失败及其管理也越来越感兴趣，并且尿道括约肌注射可能有新的适应证。
