Jung Gyoohwan, Im Young-Jae, Jang Gwan, Suh Jun Kyo, Park Kwanjin
Department of Urology, Seoul National University Children's Hospital, Seoul, Korea.
Int Neurourol J. 2021 Sep;25(3):236-243. doi: 10.5213/inj.2040326.163. Epub 2021 Mar 6.
This study aimed to determine the urodynamic characteristics of refractory enuresis and explored whether those characteristics can be managed through differential endoscopic injections with botulinum toxin.
In total, 27 patients with nonmonosymptomatic enuresis who showed no response after conservative treatment for more than 12 months were included. The patients then underwent a videourodynamic study and received a differential endoscopic injection of botulinum toxin on the same day. Reduced capacity, detrusor overactivity, and bladder neck widening were the 3 major abnormal findings assessed during the filling phase, while sphincter hyperactivity was the only abnormality assessed during the emptying phase. An intravesical or intrasphincteric injection of botulinum toxin was attempted according to the videourodynamic study findings. Follow-up was conducted at 1, 3, 6, and 12 months after treatment.
The median age was 10 years (range, 7-31 years). Although 19 and 8 patients had a preoperative diagnosis of overactive bladder or dysfunctional voiding, respectively, the urodynamic diagnosis was different in more than half of the patients. Those showing detrusor overactivity benefited from intravesical botulinum toxin injection, whereas those with only sphincter hyperactivity benefited from both intravesical and intrasphincteric injections. Treatment resistance to botulinum toxin seemed to be attributable to bladder neck widening. Time had no apparent effect on efficacy, which persisted 6 months after the injection. More than 80% of the patients maintained the benefits of the injection after 1 year.
Videourodynamic studies were useful for identifying the reasons underlying refractory nonmonosymptomatic enuresis and helpful for determining the appropriate site of botulinum toxin injection.
本研究旨在确定难治性遗尿症的尿动力学特征，并探讨这些特征是否可通过肉毒杆菌毒素的差异性内镜注射进行处理。
总共纳入了27例非单纯症状性遗尿症患者，这些患者在接受超过12个月的保守治疗后无反应。患者随后接受了视频尿动力学检查，并在同一天接受了肉毒杆菌毒素的差异性内镜注射。膀胱容量减少、逼尿肌过度活动和膀胱颈增宽是充盈期评估的3项主要异常发现，而括约肌活动亢进是排尿期评估的唯一异常。根据视频尿动力学检查结果尝试进行膀胱内或括约肌内注射肉毒杆菌毒素。在治疗后1、3、6和12个月进行随访。
中位年龄为10岁（范围为7 - 31岁）。虽然分别有19例和8例患者术前诊断为膀胱过度活动症或排尿功能障碍，但超过一半的患者尿动力学诊断不同。表现为逼尿肌过度活动的患者从膀胱内注射肉毒杆菌毒素中获益，而仅表现为括约肌活动亢进的患者从膀胱内和括约肌内注射中均获益。对肉毒杆菌毒素治疗的抵抗似乎归因于膀胱颈增宽。时间对疗效无明显影响，注射后6个月疗效持续存在。超过80%的患者在1年后仍保持注射带来的益处。
视频尿动力学检查有助于确定难治性非单纯症状性遗尿症的潜在原因，并有助于确定肉毒杆菌毒素注射的合适部位。
