Dykstra D D, Sidi A A, Scott A B, Pagel J M, Goldish G D
Department of Physical Medicine, University of Minnesota Hospital and Clinic, Minneapolis.
J Urol. 1988 May;139(5):919-22. doi: 10.1016/s0022-5347(17)42717-0.
We evaluated the ability of low doses of botulinum A toxin, an inhibitor of acetylcholine release at the neuromuscular junction, to denervate and relax the spastic rhabdosphincter in 11 men with spinal cord injury and detrusor-sphincter dyssynergia. Toxin concentration, injection volume, percutaneous versus cystoscopic injection of the sphincter and number of injections were evaluated in 3 treatment protocols. All 10 patients evaluated by electromyography after injection showed signs of sphincter denervation. Bulbosphincteric reflexes in the 10 patients evaluated after injection were more difficult to obtain, and they showed a decreased amplitude and normal latency. The urethral pressure profile in the 7 patients in whom it was measured before and after treatment decreased an average of 27 cm. water after toxin injections. Post-void residual urine volume decreased by an average of 146 cc after the toxin injections in 8 patients. In the 8 patients for whom it could be determined toxin effects lasted an average of 50 days. The toxin also decreased autonomic dysreflexia in 5 patients.
我们评估了低剂量A型肉毒杆菌毒素（一种神经肌肉接头处乙酰胆碱释放抑制剂）使11名脊髓损伤合并逼尿肌-括约肌协同失调男性患者的痉挛性横纹括约肌失神经支配并放松的能力。在3种治疗方案中评估了毒素浓度、注射体积、经皮注射与膀胱镜下括约肌注射以及注射次数。注射后接受肌电图评估的所有10名患者均显示出括约肌失神经支配的迹象。注射后接受评估的10名患者的球海绵体反射更难引出，且反射幅度降低但潜伏期正常。7名接受治疗前后尿道压力测定的患者，毒素注射后尿道压力平均下降27厘米水柱。8名患者毒素注射后残余尿量平均减少146立方厘米。在8名能够确定毒素作用的患者中，毒素作用平均持续50天。毒素还减轻了5名患者的自主神经反射异常。
