Szollar S M, Lee S M
Spinal Cord Injury Center, University of California, San Diego, 92161, USA.
Spinal Cord. 1996 May;34(5):284-7. doi: 10.1038/sc.1996.51.
The treatment of choice for the failure to restore neurogenic bladder dysfunction, managed with clean intermittent catheterization program with incontinence, is anticholinergic medication. The goal is to increase bladder capacity, and decrease intravesical pressure in order to maintain continence between catheterizations. The most commonly used anticholinergic medication in the United States is Oxybutynin. Previous clinical studies have shown that 61% of the patients on oral Oxybutynin report adverse systemic side effects and are noncompliant in taking it. In 48% of the patients, possibly due to their noncompliance, oral Oxybutynin Hydrochloride is ineffective. In this study, 13 spinal cord injured patients with a failure to restore bladder dysfunction were treated with intravesical Oxybutynin. Nine patients improved on the regimen while one patient underwent surgical bladder augmentation. Postoperatively, this patient continued to be incontinent between catheterizations. Reinstitution of intravesical Oxybutynin stabilized the patient's bladder with clean intermittent catheterization without further intervention. After 3 months post instillation in the urodynamic studies, the mean bladder capacity increased, the mean volume at first contraction increased and the leak point pressure decreased. The decrease in leak point pressure was statistically significant. Leak point pressure is one of the most important parameters we monitor to preserve upper urinary tract function. We recommend the trial of intravesical Oxybutynin for patients who fit the criteria of the protocol prior to surgical bladder augmentation.
对于采用清洁间歇性导尿方案治疗但仍存在失禁的神经源性膀胱功能障碍恢复失败的情况，首选的治疗方法是使用抗胆碱能药物。目标是增加膀胱容量并降低膀胱内压，以便在两次导尿之间保持尿失禁。在美国，最常用的抗胆碱能药物是奥昔布宁。以往的临床研究表明，口服奥昔布宁的患者中有61%报告有全身性不良反应，并且不依从服药。在48%的患者中，可能由于不依从，口服盐酸奥昔布宁无效。在本研究中，13例未能恢复膀胱功能障碍的脊髓损伤患者接受了膀胱内注射奥昔布宁治疗。9例患者在该治疗方案下病情改善，1例患者接受了膀胱扩大手术。术后，该患者在两次导尿之间仍存在尿失禁。重新采用膀胱内注射奥昔布宁后，患者通过清洁间歇性导尿使膀胱功能稳定，无需进一步干预。在膀胱内注射3个月后的尿动力学研究中，平均膀胱容量增加，首次收缩时的平均尿量增加，漏点压力降低。漏点压力的降低具有统计学意义。漏点压力是我们监测以保护上尿路功能的最重要参数之一。我们建议在进行膀胱扩大手术之前，对符合该方案标准的患者试用膀胱内注射奥昔布宁。
