Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Int J Surg. 2023 May 1;109(5):1430-1438. doi: 10.1097/JS9.0000000000000338.
Oral medications, onabotulinumtoxinA injections, and transcutaneous tibial nerve stimulation (TTNS) are recommended by the American Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction guidelines as non or minimally invasive treatments for patients with neurogenic detrusor overactivity (NDO) without treatment hierarchy.
The objective was to compare and rank the effectiveness and safety of oral medications, three doses of onabotulinumtoxinA, and TTNS on improving urodynamic outcomes in patient-reported outcomes and safety outcomes in patients with NDO.
The authors searched PubMed, EMBASE, MEDLINE, Cochrane Library, Medicine, and clinicaltrials.gov, from their inception to October 2022 and included randomized controlled studies on the drug, onabotulinumtoxinA, and TTNS for the treatment of patients with NDO. Outcomes included urodynamic parameters, voiding diary, quality of life changes, adverse event rate and postvoid residual.
A total of 26 articles and 2938 patients were included in the statistics. Regarding effectiveness, all interventions except TTNS and α-blockers were statistically different for the placebo group. The urodynamic outcome and patient-reported outcome suggested that onabotulinumtoxinA injection (urodynamic outcome: onabotulinumtoxinA 200 U, the mean surface under the cumulative ranking curve (SUCRA): 87.4; patient-reported outcome: onabotulinumtoxinA 100 U, mean SUCRA: 89.8) was the most effective treatment, and the safety outcome suggested that TTNS (SUCRA: 83.3) was the safest. Cluster analysis found that antimuscarinics and β3-adrenoceptor-agonists possessed good effectiveness and safety.
OnabotulinumtoxinA injection is probably the most effective way to treat patients with NDO, with increasing effectiveness but decreasing safety as the dose rises. The effectiveness of α-blockers and TTNS was not statistically different from the placebo group. Antimuscarinics and β3-adrenoceptor-agonists have good effectiveness and safety.
美国泌尿协会/尿动力学、女性盆底医学和泌尿生殖重建协会指南推荐口服药物、肉毒毒素 A 注射和经皮胫神经刺激（TTNS）作为治疗无治疗层次的神经源性逼尿肌过度活动（NDO）患者的非侵入性或最小侵入性治疗方法。
本研究旨在比较和评估口服药物、三种剂量的肉毒毒素 A 和 TTNS 对改善 NDO 患者尿动力学结果和安全性结果的有效性和安全性。
作者检索了 PubMed、EMBASE、MEDLINE、Cochrane 图书馆、Medicine 和 clinicaltrials.gov，从其成立到 2022 年 10 月，纳入了关于药物、肉毒毒素 A 和 TTNS 治疗 NDO 患者的随机对照研究。结果包括尿动力学参数、排尿日记、生活质量变化、不良事件发生率和残余尿量。
共有 26 篇文章和 2938 名患者纳入统计分析。关于有效性，除 TTNS 和 α-受体阻滞剂外，所有干预措施与安慰剂组相比均有统计学差异。尿动力学和患者报告的结果表明，肉毒毒素 A 注射（尿动力学结果：肉毒毒素 A 200 U，累积排序曲线下面积（SUCRA）的平均值：87.4；患者报告的结果：肉毒毒素 A 100 U，平均 SUCRA：89.8）是最有效的治疗方法，安全性结果表明 TTNS（SUCRA：83.3）是最安全的。聚类分析发现，抗毒蕈碱药物和β3-肾上腺素能激动剂具有良好的有效性和安全性。
肉毒毒素 A 注射可能是治疗 NDO 患者最有效的方法，随着剂量的增加，有效性增加，但安全性降低。α-受体阻滞剂和 TTNS 的有效性与安慰剂组无统计学差异。抗毒蕈碱药物和β3-肾上腺素能激动剂具有良好的有效性和安全性。
