Division of Pediatric Urology, School of Medicine, Marmara University, Istanbul, Turkey.
Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey.
J Urol. 2019 Jan;201(1):174-180. doi: 10.1016/j.juro.2018.06.065.
Urinary cytokines are proposed to predict urodynamic findings and outcome of intradetrusor botulinum neurotoxin type A injection in children with myelodysplasia. The relationship between urinary brain-derived neurotrophic factor and neurogenic and nonneurogenic detrusor overactivity has been shown as well. We prospectively investigated the effect of intradetrusor botulinum neurotoxin type A injection on urine brain-derived neurotrophic factor levels in children with nonneurogenic detrusor overactivity due to myelodysplasia.
Urine samples of 23 children with nonneurogenic detrusor overactivity due to myelodysplasia were collected and analyzed before and 1 and 3 months after intradetrusor botulinum neurotoxin type A injection, and urodynamics were performed before and 6 weeks after injection. Brain-derived neurotrophic factor levels and urodynamic findings were analyzed and statistical comparisons were done.
Mean ± SD age was 100.0 ± 34.5 months. Ratio of girls to boys was 2.8. Brain-derived neurotrophic factor levels significantly decreased (p <0.006), and maximum cystometric capacity and maximum detrusor pressure improved significantly following intradetrusor botulinum neurotoxin type A injection compared to preoperatively (p <0.001). No statistical correlations were determined between brain-derived neurotrophic factor levels and urodynamics. Of all analyses only bladder compliance 5 ml/cm H2O or less vs greater than 5 ml/cm H2O at postoperative urodynamics was associated with statistically increased urine brain-derived neurotrophic factor levels, suggesting that increased urine brain-derived neurotrophic factor predicts treatment failure.
The present study does not suggest that urine brain-derived neurotrophic factor is a reliable followup marker in children with nonneurogenic detrusor overactivity due to myelodysplasia. However, this factor may have a role in treatment planning, which needs to be established in future large prospective studies.
尿细胞因子被认为可以预测脊髓发育不良儿童中经尿道注射肉毒毒素 A 后的尿动力学结果和结局。也已经证明，尿脑源性神经营养因子与神经源性和非神经源性逼尿肌过度活动之间存在关系。我们前瞻性研究了经尿道注射肉毒毒素 A 对脊髓发育不良引起的非神经源性逼尿肌过度活动患儿尿液脑源性神经营养因子水平的影响。
收集 23 例脊髓发育不良引起的非神经源性逼尿肌过度活动患儿的尿样，在注射肉毒毒素 A 前、后 1 个月和 3 个月进行分析，并在注射前和 6 周后进行尿动力学检查。分析脑源性神经营养因子水平和尿动力学检查结果，并进行统计学比较。
平均年龄 ± 标准差为 100.0 ± 34.5 个月。男女比例为 2.8。与术前相比，注射肉毒毒素 A 后，脑源性神经营养因子水平显著降低（p<0.006），最大膀胱容量和最大逼尿肌压显著改善（p<0.001）。脑源性神经营养因子水平与尿动力学之间未发现统计学相关性。在所有分析中，仅术后尿动力学检查中膀胱顺应性为 5ml/cmH2O 或以下与大于 5ml/cmH2O 与尿液脑源性神经营养因子水平升高相关，表明尿液脑源性神经营养因子水平升高预示着治疗失败。
本研究表明，尿脑源性神经营养因子不是脊髓发育不良儿童非神经源性逼尿肌过度活动的可靠随访标志物。然而，该因素可能在治疗计划中具有一定作用，这需要在未来的大型前瞻性研究中确定。
