Department of Urology, University of Rouen , Rouen , France.
Department of Urology, University of Rennes , Rennes , France.
J Urol. 2019 Apr;201(4):769-776. doi: 10.1016/j.juro.2018.10.012.
Data are lacking on long-term outcomes of intradetrusor injections of botulinum toxin A for neurogenic detrusor overactivity. The aim of this study was to assess the outcomes of intradetrusor injections of botulinum toxin A for neurogenic detrusor overactivity after more than 10 years of followup.
We retrospectively reviewed the charts of all consecutive neurological patients who had received onabotulinumtoxin A or abobotulinumtoxin A intradetrusor injections for neurogenic detrusor overactivity between January 2002 and November 2007 at a total of 3 academic centers. The primary outcome measure was the 10-year discontinuation rate. Other outcomes of interest were failure, reasons for discontinuation and subsequent treatments of neurogenic detrusor overactivity. Discontinuation-free and failure-free survival was estimated by Kaplan-Meier analyses.
A total of 140 patients were included in study. The 10-year discontinuation-free and failure-free survival rates were 49.1% and 73%, respectively. The most common reason for discontinuation was failure in 43.7% of cases, which was primary and secondary in 17.2% and 26.5%, respectively. Secondary failure occurred after a median of 8 injections and a median of 80.1 months from the first injection. Other reasons for discontinuation were patient decision in 28.1% of patients, nonbotulinum toxin A related improvement of urinary incontinence in 14.1%, neurological condition progression in 12.5% and an adverse event in 1.6%. Discontinuation-free survival was significantly poorer in patients with spina bifida than in patients with multiple sclerosis or spinal cord injury (p = 0.02).
More than half of the patients with neurogenic detrusor overactivity discontinued intradetrusor botulinum toxin A within the first 10 years after the initial injection. Patients with spina bifida are at high risk for discontinuation.
关于肉毒毒素 A 膀胱内注射治疗神经原性逼尿肌过度活动的长期疗效数据尚缺乏。本研究旨在评估初次注射肉毒毒素 A 膀胱内治疗 10 年以上的神经原性逼尿肌过度活动患者的长期结局。
我们回顾性分析了 2002 年 1 月至 2007 年 11 月期间在 3 家学术中心连续接受过膀胱内注射肉毒毒素 A（包括注射用 A 型肉毒毒素和注射用 B 型肉毒毒素）治疗神经原性逼尿肌过度活动的所有神经科患者的病历。主要观察指标为 10 年停药率。其他观察指标包括治疗失败、停药原因以及后续的神经原性逼尿肌过度活动治疗方法。采用 Kaplan-Meier 分析法评估停药无失败和失败无失败生存率。
共纳入 140 例患者。10 年停药无失败和失败无失败生存率分别为 49.1%和 73.0%。最常见的停药原因为治疗失败（43.7%），其中原发性和继发性失败分别占 17.2%和 26.5%。继发性失败发生在初次注射后中位数 8 次和中位数 80.1 个月后。其他停药原因包括患者决定（28.1%）、非肉毒毒素 A 相关的尿失禁改善（14.1%）、神经疾病进展（12.5%）和不良反应（1.6%）。与多发性硬化症或脊髓损伤患者相比，脊髓脊膜膨出患者的停药无失败生存率显著更差（p = 0.02）。
初次注射肉毒毒素 A 膀胱内治疗后 10 年内，超过一半的神经原性逼尿肌过度活动患者停止了治疗。脊髓脊膜膨出患者停药风险高。
