Krishnappa Pramod, Sinha Maneesh, Krishnamoorthy Venkatesh
Department of Urology, NU Hospitals, Bangalore, India.
Clin Med Insights Womens Health. 2018 Nov 22;11:1179562X18811340. doi: 10.1177/1179562X18811340. eCollection 2018.
To assess the outcomes of Botulinum Toxin-A (BoNT-A) to the external urethral sphincter (EUS) in dysfunctional voiding (DV) refractory to standard urotherapy and bowel management.
Our criteria to diagnose DV in women included neurologically normal individuals with lower urinary tract symptoms, dilated proximal urethra on voiding cystourethrogram, and high detrusor pressure (PdetQmax > 20 cm HO) associated with increased electromyography activity during voiding in urodynamic study (UDS). A total of 16 female patients with a median age of 36 years (5-60 years) received BoNT-A from June 2014 to December 2015. Patients below and above 10 years of age received 100 units and 200 units of BoNT-A to EUS, respectively. Patients were followed up till 6 months.
Mean AUA (American Urological Association) symptom score decreased significantly from 11.75 ± 6.14 to 5.06 ± 5.1 and 4.25 ± 3.4 at day 14 and day 45 after BoNT-A, respectively ( < .0001). There were no significant improvements in maximal flow (Qmax) on uroflowmetry (UFM) and detrusor pressure at maximal flow (PdetQmax) in UDS. Significant reduction in post-void residual (PVR) from 69.31 ± 77.3 to 17.50 ± 22.3 mL at day 14 ( = .007) was observed, although the reduction was not significant at day 45. Although minor adverse effects were reported, none were serious or life-threatening.
Our study showed that BoNT-A plays a role in improvement of urinary symptoms and reduces PVR at D14 in DV, but showed no improvement in UFM and urodynamic parameters, albeit with limited numbers and limited follow-up.
评估A型肉毒杆菌毒素（BoNT-A）注射至尿道外括约肌（EUS）对标准尿疗法和肠道管理无效的功能性排尿障碍（DV）的治疗效果。
我们诊断女性DV的标准包括：神经系统正常但有下尿路症状、排尿性膀胱尿道造影显示近端尿道扩张、尿动力学检查（UDS）中排尿时逼尿肌压力升高（PdetQmax＞20cmH₂O）且肌电图活动增加。2014年6月至2015年12月，共有16例中位年龄为36岁（5-60岁）的女性患者接受了BoNT-A治疗。10岁及以下和10岁以上的患者分别接受100单位和200单位的BoNT-A注射至EUS。对患者随访至6个月。
美国泌尿外科学会（AUA）症状平均评分在注射BoNT-A后第14天和第45天分别从11.75±6.14显著降至5.06±5.1和4.25±3.4（P＜.0001）。尿流率测定（UFM）中的最大尿流率（Qmax）和UDS中的最大尿流率时逼尿肌压力（PdetQmax）无显著改善。第14天观察到残余尿量（PVR）从69.31±77.3显著降至17.50±22.3mL（P=.007），尽管在第45天降低不显著。虽然报告了轻微不良反应，但均不严重或危及生命。
我们的研究表明，BoNT-A在改善DV患者的排尿症状和降低第14天的PVR方面发挥作用，但在UFM和尿动力学参数方面无改善，尽管样本量有限且随访时间有限。
