Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Medicine, Mackay Medical College, Taipei, Taiwan.
Low Urin Tract Symptoms. 2020 May;12(2):109-116. doi: 10.1111/luts.12304. Epub 2020 Feb 19.
Overactive bladder (OAB) is a common condition affecting one-sixth to one-fifth of the global population. The treatment of refractory OAB remains a challenge for urologists. Current treatment options include the use of combination therapy with antimuscarinic agents and beta-3 adrenoceptor agonists, and treating underlying curable disorders. Intravesical botulinum toxin type A (BoNT-A) injection, percutaneous tibial nerve stimulation, and sacral nerve stimulation are third-line management therapies suggested by the American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/SUFU) guidelines. In rare cases, more invasive surgical interventions can be considered after explaining the benefits and risks to the patients. Augmentation cystoplasty has a high success rate; however, it has also been associated with a high complication rate. In contrast, detrusor myomectomy is an easy procedure, but the treatment outcome remains controversial. Liposome-encapsulated BoNT-A is administered via bladder instillation, and promising results have been obtained in preliminary studies. More therapies are currently being investigated, and transient receptor potential vanilloid 1 antagonists may be new type of medication. Radiofrequency ablation and other targets for neuromodulation have also been studied; however, more evidence is needed to confirm their efficacy.
膀胱过度活动症（OAB）是一种常见病症，影响全球六分之一到五分之一的人口。治疗难治性 OAB 仍然是泌尿科医生面临的挑战。目前的治疗选择包括使用抗毒蕈碱药物和β3 肾上腺素能受体激动剂的联合治疗，以及治疗潜在可治愈的疾病。美国泌尿科协会/尿动力学、女性盆底医学和泌尿生殖重建学会（AUA/SUFU）指南建议，经皮胫神经刺激和骶神经刺激是二线治疗方法。在极少数情况下，如果向患者解释了获益和风险，可能会考虑更具侵入性的手术干预。膀胱扩大术成功率高，但也与高并发症发生率相关。相比之下，逼尿肌肌瘤切除术是一种简单的手术，但治疗效果仍存在争议。包封在脂质体中的 BoNT-A 通过膀胱灌注给药，初步研究取得了有希望的结果。目前正在研究更多的治疗方法，瞬时受体电位香草素 1 拮抗剂可能是一种新型药物。射频消融和其他神经调节靶点也进行了研究，但需要更多的证据来证实其疗效。
