Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, U.S.
Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, U.S..
Curr Urol Rep. 2024 Dec;25(12):331-338. doi: 10.1007/s11934-024-01227-3. Epub 2024 Aug 2.
The aim of this article is to review considerations and efficacy of third-line treatments for pediatric non-neurogenic bladder dysfunction, including Botulinum toxin A (BoTNA), Posterior Tibial Nerve Stimulation (PTNS), and Sacral Neuromodulation (SNM).
Federal Drug Administration approval for use of beta-3-agonists in overactive detrusor activity in pediatric patients may provide an additional step prior to third-line therapies. New long-term data on pediatric SNM efficacy, complications, and revision rates will provide valuable information for counseling families. BoTNA offers a safe and efficacious treatment to decrease detrusor contractility and improve bladder capacity but is limited by the half-life of BoNTA agent. Percutaneous or transcutaneous PTNS offers improved voided volumes or cure in some patients but is time-intensive. SNM can be utilized in a variety of LUTD pathology with high success rate and cure but should consider cumulative anesthetic and fluoroscopic exposures for battery replacements and re-positioning for patient growth.
本文旨在回顾儿科非神经源性膀胱功能障碍的三线治疗的注意事项和疗效，包括肉毒杆菌毒素 A（BoTNA）、胫后神经刺激（PTNS）和骶神经调节（SNM）。
β-3-激动剂在小儿逼尿肌过度活动中的应用获得美国食品和药物管理局批准，这可能是三线治疗前的又一步。关于儿科 SNM 疗效、并发症和再手术率的新长期数据将为患者家庭提供有价值的咨询信息。BoTNA 提供了一种安全有效的治疗方法，可以降低逼尿肌收缩力，增加膀胱容量，但受到 BoNTA 制剂半衰期的限制。经皮或经皮 PTNS 可改善一些患者的排空量或治愈，但时间密集。SNM 可用于多种 LUTD 病理，成功率和治愈率高，但应考虑累积麻醉和荧光透视暴露，以更换电池和因患者生长而重新定位。
