Riedl C R, Knoll M, Plas E, Pflüger H
Department of Urology and Ludwig Boltzmann Institute of Andrology, Municipal Hospital Lainz, Vienna, Austria.
J Urol. 1998 Jun;159(6):1851-6. doi: 10.1016/S0022-5347(01)63174-4.
We performed intravesical electromotive drug administration (EMDA) for various bladder disorders during a 3-year period and assessed the technique, possible applications, complications and outcomes of this procedure.
Intravesical EMDA was performed with local anesthetics for transurethral surgery and in combination with dexamethasone for the treatment of noninfectious chronic cystitis (interstitial/radiation cystitis), with mitomycin C for recurrence prophylaxis of high risk superficial bladder cancer and with oxybutynin/bethanechol for the hyperreflexive/acontractile detrusor. A standardized power source and electrode catheter were used for 215 treatments in 84 patients.
Transurethral bladder tumor resections were pain-free in 10 of 12 patients. Of the 25 patients with chronic noninfectious cystitis 15 were free of symptoms for a mean of 6.6 months, and there was a 73% increase in mean bladder capacity from 244 before to 421 cc after EMDA. Of the 16 patients with superficial bladder cancer 9 were free of recurrence for a mean of 14.1 months. In 10 of 14 patients with acontractile detrusors urodynamic examination showed detrusor contraction during EMDA of bethanechol. There were no contractions without electric current. EMDA of oxybutynin reduced detrusor hyperreflexia. A bladder ulcer was the single severe local complication and 4.6% of patients, mainly those with chronic cystitis, reported significant post-EMDA bladder/urethral pain. Minor side effects accounted for 23% of all treatments. No systemic side effects occurred.
Intravesical EMDA is effective and innocuous. The therapeutic concept combines the advantages of increased drug administration without systemic side effects.
我们在3年期间对各种膀胱疾病进行了膀胱内电动药物灌注（EMDA），并评估了该操作技术、可能的应用、并发症及结果。
膀胱内EMDA在经尿道手术中联合局部麻醉剂使用，在治疗非感染性慢性膀胱炎（间质性/放射性膀胱炎）时联合地塞米松，在预防高危浅表性膀胱癌复发时联合丝裂霉素C，在治疗逼尿肌反射亢进/无收缩力时联合奥昔布宁/氨甲酰甲胆碱。使用标准化电源和电极导管对84例患者进行了215次治疗。
12例患者中有10例经尿道膀胱肿瘤切除术时无疼痛。25例慢性非感染性膀胱炎患者中，15例症状消失，平均持续6.6个月，EMDA后膀胱平均容量从之前的244立方厘米增加到421立方厘米，增幅为73%。16例浅表性膀胱癌患者中，9例无复发，平均持续14.1个月。14例逼尿肌无收缩力患者中有10例，尿动力学检查显示在氨甲酰甲胆碱EMDA期间逼尿肌收缩。无电流时无收缩。奥昔布宁的EMDA减轻了逼尿肌反射亢进。膀胱溃疡是唯一的严重局部并发症，4.6%的患者（主要是慢性膀胱炎患者）报告EMDA后膀胱/尿道疼痛明显。轻微副作用占所有治疗的23%。未发生全身副作用。
膀胱内EMDA有效且无害。该治疗理念结合了增加药物灌注而无全身副作用的优点。
