Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan.
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, 707, Section 3, Chung Yang Road, Hualien 97002, Taiwan.
Toxins (Basel). 2024 Jul 31;16(8):336. doi: 10.3390/toxins16080336.
Spinal cord injury (SCI) often leads to neurogenic lower urinary tract dysfunction, causing dysuria and affecting patients' well-being. This study aimed to evaluate the efficacy of a urethral sphincter botulinum toxin A (BoNT-A) injection in patients with SCI and dysuria. This was a retrospective study including 118 patients with SCI who underwent a urethral BoNT-A injection following a standardized protocol for refractory voiding dysfunction. The protocol involved injecting BoNT-A into the urethral sphincter under cystoscopic guidance. Patient demographics, bladder condition parameters, and treatment outcomes were analyzed. Logistic regression and receiver operating characteristic curve analyses were performed to identify predictors of treatment success. Of the 118 patients, 71 (60.1%) showed satisfactory treatment outcomes after the injection. Post-injection status, bladder management, and injection frequency varied significantly among patients with satisfactory and unsatisfactory treatment outcomes. Age, bladder compliance, intravesical pressure, and bladder contractility were indicators of satisfactory outcomes. The first sensation of bladder filling of ≤263 mL, intravesical pressure of ≤28, and bladder contractility index of ≥14 were highly correlated with satisfactory outcomes. A urethral sphincter BoNT-A injection shows promise in managing dysuria in patients with SCI. Understanding bladder condition parameters and patient demographics helps optimize patient selection for this intervention. Further studies are needed to validate these findings and refine treatment protocols.
脊髓损伤（SCI）常导致神经源性下尿路功能障碍，引起排尿困难，影响患者的生活质量。本研究旨在评估尿道括约肌肉毒毒素 A（BoNT-A）注射治疗 SCI 伴排尿困难患者的疗效。这是一项回顾性研究，纳入了 118 例接受尿道 BoNT-A 注射的 SCI 患者，这些患者均符合难治性排尿功能障碍的标准方案。该方案涉及在膀胱镜引导下将 BoNT-A 注射到尿道括约肌中。分析患者的人口统计学、膀胱状况参数和治疗结果。采用逻辑回归和受试者工作特征曲线分析来确定治疗成功的预测因素。在 118 例患者中，71 例（60.1%）在注射后获得满意的治疗效果。注射后状态、膀胱管理和注射频率在治疗效果满意和不满意的患者中差异显著。年龄、膀胱顺应性、膀胱内压和膀胱收缩性是治疗效果满意的指标。首次膀胱充盈感≤263mL、膀胱内压≤28mmHg 和膀胱收缩性指数≥14 与治疗效果满意高度相关。尿道括约肌 BoNT-A 注射在治疗 SCI 患者排尿困难方面具有一定的前景。了解膀胱状况参数和患者的人口统计学特征有助于为该干预措施选择合适的患者。需要进一步的研究来验证这些发现并完善治疗方案。
