Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Investig Clin Urol. 2019 Jan;60(1):40-45. doi: 10.4111/icu.2019.60.1.40. Epub 2018 Dec 24.
OnabotulinumtoxinA (BTX) detrusor chemodenervation is an efficacious third-line treatment for overactive bladder. Despite high clinical efficacy rates for BTX injection, many patients refuse initial or repeat treatment due to the invasiveness of the cystoscopic route of delivery. We assess the feasibility of injecting the trigone and posterior bladder wall via a transvaginal route under ultrasound guidance using a human cadaveric model.
Eight de-identified anonymous fresh female deceased donor cadaver pelvises were placed in supine split leg position. A transvaginal ultrasound probe guided injections of India ink into the trigone in 3 sites and the posterior wall in 2 sites. Full thickness bladder biopsies were then obtained and histologic analysis was performed to confirm presence of India ink in the detrusor layer.
The mean time from day of death was 11.0 days (range, 4.0-23.0 days). Three to five bladder biopsies were obtained per cadaver, for a total of 34 specimens (20 trigone, 14 posterior wall). Histologic analysis revealed presence of India ink within the detrusor layer in 8/8 (100.0%) of cadavers. The surgeon's perception of appropriate targeting under ultrasound guidance was confirmed in 8/8 cadavers (100.0%) involving the bladder trigone, and 7/8 (87.5%) involving the posterior wall. Of injections that were believed to have appropriately targeted the detrusor layer, 22/34 specimens (64.7%) demonstrated the presence of India ink under histologic analysis.
Intradetrusor injection of the bladder trigone and posterior wall under transvaginal ultrasound guidance is feasible and has acceptable accuracy.
肉毒杆菌毒素 A（BTX）逼尿肌化学去神经支配是治疗膀胱过度活动症的有效三线治疗方法。尽管 BTX 注射的临床疗效很高，但由于经膀胱镜递送途径的侵袭性，许多患者拒绝初始或重复治疗。我们评估了在超声引导下经阴道途径注射三角区和膀胱后壁的可行性，使用人体尸体模型。
将 8 具去标识匿名新鲜女性已故供体骨盆置于仰卧分腿位。经阴道超声探头引导印度墨水在三角区的 3 个部位和后壁的 2 个部位注射。然后获得全层膀胱活检，并进行组织学分析以确认墨水是否存在于逼尿肌层。
从死亡之日起的平均时间为 11.0 天（范围，4.0-23.0 天）。每个尸体获得 3-5 个膀胱活检，共 34 个标本（20 个三角区，14 个后壁）。组织学分析显示，8/8（100.0%）具尸体的逼尿肌层内存在印度墨水。8/8 具尸体（100.0%）涉及膀胱三角区，7/8 具尸体（87.5%）涉及后壁，超声引导下的手术医生对适当靶向的感知得到证实。在认为适当靶向逼尿肌层的注射中，34 个标本中有 22 个（64.7%）在组织学分析中显示存在印度墨水。
经阴道超声引导下逼尿肌内注射膀胱三角区和后壁是可行的，且具有可接受的准确性。
