Department of Urology, Chung Shan Medical University Hospital; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
J Rehabil Med. 2022 Mar 29;54:jrm00264. doi: 10.2340/jrm.v54.122.
To investigate the effects of concomitant injections of botulinum toxin-A (BoNT-A) into the detrusor and external urethral sphincter muscles in suprasacral spinal cord injured patients with detrusor overactivity and detrusor sphincter dyssynergia.
An open treatment trial with pre- and posttreatment evaluations.
Male suprasacral spinal cord injury patients (n = 20) with neurogenic detrusor overactivity and detrusor sphincter dyssynergia who emptied their bladder by reflex voiding and were unwilling to increase the frequency of intermittent catheterization.
Cystoscopic guidance of 200 U BoNT-A injections into the detrusor muscle and 100 U into external urethral sphincter muscles were applied. The urodynamic parameters, voiding diaries and quality of life scores using Urinary Distress Inventory, Short Form (UDI-6) and Incontinence Impact Questionnaire, Short Form (IIQ-7) were compared.
All participants experienced a significant mean reduction in maximal detrusor pressure and maximal urethral pressure profile, and a mean significant increase in maximal cystometric bladder capacity 12 weeks after concomitant injections. Bladder diaries demonstrated persistently increased spontaneous voided volume, but no increase in post-void residual ratio, daily clean intermittent catheterization (CIC) frequency and diaper pad use from baseline to 24 weeks. UDI-6 scores were significantly improved at 4 and 12 weeks and IIQ-7 scores improved only at 12 weeks.
Concomitant detrusor and external urethral sphincter BoNT-A injections may decrease detrusor and urethral pressure without increasing postvoid residual ratio and diaper pad use. For spinal cord injury patients with neurogenic detrusor overactivity and detrusor sphincter dyssynergia who are unwilling, or for whom it is inconvenient, to increase CIC frequency and who want to preserve spontaneous voiding, this treatment may provide an optional alternative.
探讨在骶上脊髓损伤伴逼尿肌过度活动和逼尿肌括约肌协同失调的患者中，同时向逼尿肌和尿道外括约肌注射肉毒毒素 A（BoNT-A）的效果。
具有治疗前和治疗后评估的开放性治疗试验。
20 例男性骶上脊髓损伤患者（n = 20），患有神经源性逼尿肌过度活动和逼尿肌括约肌协同失调，通过反射性排尿排空膀胱，且不愿意增加间歇性导尿的频率。
在膀胱镜引导下，向逼尿肌注射 200U BoNT-A，向尿道外括约肌注射 100U。比较尿动力学参数、排尿日记和生活质量评分，使用尿失禁困扰量表（UDI-6）和失禁影响问卷短表（IIQ-7）。
所有参与者在同时注射后 12 周时均经历了最大逼尿肌压力和最大尿道压力图的显著平均降低，以及最大膀胱容量的显著平均增加。膀胱日记显示自发性排空量持续增加，但从基线到 24 周时，残余尿量比例、每日清洁间歇性导尿（CIC）频率和尿布使用量均无增加。UDI-6 评分在 4 周和 12 周时显著改善，IIQ-7 评分仅在 12 周时改善。
同时向逼尿肌和尿道外括约肌注射 BoNT-A 可能会降低逼尿肌和尿道压力，而不会增加残余尿量比例和尿布使用量。对于不愿意或不方便增加 CIC 频率且希望保留自主排尿的神经源性逼尿肌过度活动和逼尿肌括约肌协同失调的脊髓损伤患者，这种治疗可能是一种可选的替代方案。
