女性慢性尿潴留患者尿道周围括约肌注射肉毒杆菌毒素的长期疗效

Long-term Outcomes of Periurethral Sphincter Botulinum Toxin in Female Chronic Urinary Retention.

作者信息

Wright Sarah L, Ananthavarathan Piriyankan, Simeoni Sara, Malladi Prasad, Pakzad Mahreen, Panicker Jalesh N

机构信息

Department of Uro Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.

UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK.

出版信息

Int Neurourol J. 2024 Sep;28(3):207-214. doi: 10.5213/inj.2448176.088. Epub 2024 Sep 30.

DOI:10.5213/inj.2448176.088

PMID:39363411

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11450239/

Abstract

PURPOSE

Nonneurogenic chronic urinary retention is an uncommon problem in young female individuals, and a well characterised causes is Fowler syndrome (primary disorder of urethral sphincter relaxation). Intermittent catheterisation is often challenging, and gold standard treatment sacral neuromodulation is not widely available. Urethral sphincter botulinum toxin injection has been shown to be effective cross-sectionally, however little is known about long-term outcomes.

METHODS

Female individuals presenting with urinary retention due to Fowler syndrome were reviewed retrospectively from a single tertiary referral centre over an 11-year period (2010-2021). One hundred units of onabotulinum toxin A (BoTX-A) was injected into the striated urethral sphincter in a divided dose by the periurethral approach. Efficacy and side effects were assessed 4 weeks after injection.

RESULTS

Thirty-three female individuals with a mean age of 40.1±14.1 years received 165 unique urethral sphincter BoTX-A injections over 11 years. Nineteen individuals (57.6%) presented in acute urinary retention, and 28 (84.8%) were reliant on catheterisation. Twenty-one individuals (64%) responded to BoTX-A injections and had a significantly raised baseline maximum urethral closure pressure (MUCP), compared to nonresponders (114.6 cm H2O, P=0.012). Side effects were reported following 19 injections (11.5%) however, were mild and transient. Fifteen individuals received more than 1 botulinum toxin injection (median, 3 injections), with a median interval of 112 days (interquartile range) and efficacy persisted following repeat injections and no safety concerns were seen.

CONCLUSION

Sphincter botulinum toxin through the periurethral approach is safe and effective following repeat injections, and offers a low-cost, minimally invasive alternative to managing female chronic urinary retention due to Fowler syndrome, particularly when there was a high baseline MUCP.

摘要

目的

非神经源性慢性尿潴留在年轻女性中是一个不常见的问题，一种特征明确的病因是福勒综合征（尿道括约肌松弛的原发性疾病）。间歇性导尿往往具有挑战性，而金标准治疗骶神经调节并不广泛可用。尿道括约肌肉毒杆菌毒素注射已被证明在横断面研究中是有效的，然而对其长期结果知之甚少。

方法

对一家三级转诊中心在11年期间（2010 - 2021年）因福勒综合征出现尿潴留的女性患者进行回顾性研究。通过尿道周围途径将100单位的A型肉毒杆菌毒素（BoTX - A）分剂量注射到尿道横纹肌括约肌中。注射后4周评估疗效和副作用。

结果

33名平均年龄为40.1±14.1岁的女性在11年期间接受了165次独特的尿道括约肌BoTX - A注射。19名个体（57.6%）表现为急性尿潴留，28名（84.8%）依赖导尿。21名个体（64%）对BoTX - A注射有反应，与无反应者相比，其基线最大尿道闭合压（MUCP）显著升高（114.6 cm H2O，P = 0.012）。19次注射（11.5%）后报告有副作用，但均为轻度且短暂。15名个体接受了不止一次肉毒杆菌毒素注射（中位数为3次），注射间隔中位数为112天（四分位间距），重复注射后疗效持续，未见安全问题。