Cakici Ozer Ural, Kaya Coskun, Sanci Adem, Gencler Onur Serdar, Mammadkhanli Orkhan, Cindas Abdullah
Department of Urology, Yuksek Ihtisas University affiliated Medical Park Ankara Hospital, Ankara, Turkey.
Department of Urology, Eskisehir State Hospital, Eskisehir, Turkey.
Cent European J Urol. 2021;74(4):547-551. doi: 10.5173/ceju.2021.161. Epub 2021 Oct 28.
Spinal cord injury is a major cause of lifelong morbidity and functional micturition problems. Some patients are refractory to the available therapeutics, even when used in combination. In this paper we report our results of using gabapentin as an add-on treatment in refractory overactive detrusor cases secondary to spinal cord injury.
A total of 27 patients who had a spinal cord injury between the levels of the second thoracic and fourth lumbar vertebrae and had an overactive detrusor in urodynamic studies were included in this retrospective study. The patients were selected due to the fact that they also had not responded to a combination of an anticholinergic and mirabegron and had neuropathic pain. Gabapentin treatment was added to the previous therapy. Demographics, previous treatments, chronic conditions, urodynamic findings, clinical and urodynamic responses are reported in this paper.
We observed a response to treatment in the urodynamic studies of 11 patients (40.17%), in terms of decreased detrusor contractions, maximal detrusor pressure, and the number of incontinence episodes. Sixteen patients did not respond to the gabapentin add-on therapy and were referred for Botulinum toxin injections to the bladder.
Gabapentin add-on therapy can be considered as a third or further option, before Botulinum toxin injection, for patients with neurogenic overactive detrusor who did not respond to the combination of anticholinergics and mirabegron. The approved usage of gabapentin for neurogenic pain justifies its usage in this area. In our selected patient group, who had not responded to the combination therapy, we observed a clinical benefit in one-third of the patients.
脊髓损伤是导致终身发病和功能性排尿问题的主要原因。即使联合使用现有治疗方法，一些患者仍对其难治。本文报告了我们使用加巴喷丁作为脊髓损伤继发难治性逼尿肌过度活动病例附加治疗的结果。
本回顾性研究纳入了27例脊髓损伤位于第二胸椎至第四腰椎水平且尿动力学研究显示逼尿肌过度活动的患者。选择这些患者是因为他们对抗胆碱能药物和米拉贝隆的联合治疗无反应且患有神经性疼痛。在先前治疗基础上加用加巴喷丁治疗。本文报告了患者的人口统计学资料、先前治疗情况、慢性病情况、尿动力学检查结果、临床和尿动力学反应。
在尿动力学研究中，我们观察到11例患者（40.17%）对治疗有反应，表现为逼尿肌收缩、最大逼尿肌压力和尿失禁发作次数减少。16例患者对加巴喷丁附加治疗无反应，被转诊接受膀胱肉毒毒素注射。
对于对抗胆碱能药物和米拉贝隆联合治疗无反应的神经源性逼尿肌过度活动患者，在注射肉毒毒素之前，加巴喷丁附加治疗可被视为第三种或更后续的选择。加巴喷丁获批用于神经性疼痛证明了其在该领域的应用合理性。在我们选择的对联合治疗无反应的患者组中，我们观察到三分之一的患者有临床获益。
