University College London Hospitals, London, UK.
Neurourol Urodyn. 2022 Nov;41(8):1793-1799. doi: 10.1002/nau.25023. Epub 2022 Aug 18.
The aim of this study is to examine the functional outcomes of ona-botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD).
A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX-A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI-I) scale at 6 weeks and then at 3 monthly intervals.
We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18-72 years) with a mean follow-up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self-catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX-A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVR decreased from 200 to 149 mls (p < 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actual MUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5-point PGI-I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for <6 weeks) and there were no significant long-lasting adverse events.
EUS BTX-A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments.
本研究旨在探讨在外部尿道括约肌（EUS）中注射肉毒毒素 A（BTX-A）对非神经源性非弛缓性括约肌导致排尿功能障碍（VD）的女性患者的功能结局。
对研究期间首次接受治疗的所有逼尿肌压力高于预期最大值（MUCP）的患者进行回顾性分析。所有患者均进行术前尿动力学研究和尿道压力描记术，并接受 100U 的 EUS BTX-A。排除年龄小于 18 岁和患有神经性膀胱的患者。所有患者在 6 周和 3 个月后进行随访，评估其自由流率、残余尿量（PVR）和患者总体改善印象（PGI-I）评分。
我们共确定了 35 名年龄平均为 37.5±15 岁（年龄 18-72 岁）的女性患者，平均随访 20 个月。超过 50%的患者有既往手术史，28（80%）例患者需要留置导尿管、耻骨上导尿或间歇性清洁导尿。平均 MUCP 为 97.1±22cm 水柱。BTX-A 治疗后，21（60%）例患者能够经尿道排尿（p=0.02）。最大尿流率（Qmax）从 8.8 增加到 11ml/s，PVR 从 200 减少到 149ml（p＜0.05）。多因素分析显示，术前高 PVR、术前实际 MUCP 和既往手术干预（尿道扩张、骶神经调节和盆腔手术）是成功恢复排尿的预测因素。平均反应持续时间为 4.7 个月，46%的患者要求重复注射，29%的患者接受维持性注射。在 5 分 PGI-I 评分中，13（37%）、12（34%）和 10（29%）例患者分别报告为良好、有些和无改善。60%的患者生活质量也得到了改善。有 2 例患者出现短暂性压力性尿失禁（＜6 周），没有明显的长期不良事件。
考虑到治疗选择有限，EUS BTX-A 是治疗 VD 的有效选择。必须让患者了解需要重复治疗。
