Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan.
Department of Urology, Buddhist Tzu Chi University, Hualien 970, Taiwan.
Toxins (Basel). 2020 Mar 9;12(3):166. doi: 10.3390/toxins12030166.
Bladder oversensitivity arises from several different conditions involving the bladder, bladder outlet, systemic or central nervous system diseases. Increase of the bladder sensation results from activation of the sensory receptors in the urothelial cells or suburothelial tissues. Medical treatment targeting the overactive bladder (OAB) or interstitial cystitis (IC) might relieve oversensitive bladder symptoms (frequency, urgency and pain) in a portion of patients, but a certain percentage of patients still need active management. Botulinum toxin A (BoNT-A) has been demonstrated to have anti-inflammatory and antinociceptive effects in bladder sensory disorders and has been shown effective in the reduction of bladder oversensitivity and the increase of functional bladder capacity. For patients with OAB, urgency and urinary incontinence improved, while in patients with IC, bladder pain could be relieved in association with reduction of bladder oversensitivity after BoNT-A intravesical injection. Histological evidence has confirmed the therapeutic mechanism and clinical efficacy of intravesical BoNT-A injection on patients with OAB or IC. Bladder oversensitivity can also be relieved with the instillation of liposome encapsulated BoNT-A or low energy show waves (LESWs), which enable the BoNT-A molecule to penetrate into the urothelium and suburothelial space without affecting the detrusor contractility. Liposome encapsulated BoNT-A or combined LESWs and BoNT-A instillation might be future treatment alternatives for bladder oversensitivity in sensory bladder disorders.
膀胱过度敏感是由几种不同的情况引起的，涉及膀胱、膀胱出口、系统性或中枢神经系统疾病。膀胱感觉的增加是由于尿路上皮细胞或下尿路组织中的感觉受体被激活。针对膀胱过度活动症（OAB）或间质性膀胱炎（IC）的医学治疗可能会缓解部分患者的膀胱过度敏感症状（频率、尿急和疼痛），但仍有一定比例的患者需要积极管理。肉毒杆菌毒素 A（BoNT-A）已被证明在膀胱感觉障碍中具有抗炎和镇痛作用，并已被证明可有效降低膀胱过度敏感和增加功能性膀胱容量。对于 OAB 患者，尿急和尿失禁得到改善，而对于 IC 患者，膀胱疼痛可以缓解，同时膀胱过度敏感也降低。组织学证据证实了膀胱内注射 BoNT-A 治疗 OAB 或 IC 患者的治疗机制和临床疗效。通过膀胱内注射脂质体包裹的 BoNT-A 或低能量冲击波（LESWs）也可以缓解膀胱过度敏感，使 BoNT-A 分子穿透尿路上皮和下尿路组织，而不会影响逼尿肌收缩力。脂质体包裹的 BoNT-A 或联合 LESWs 和 BoNT-A 灌注可能是未来治疗感觉性膀胱疾病中膀胱过度敏感的替代方法。
