Gallien P, Robineau S, Verin M, Le Bot M P, Nicolas B, Brissot R
Clinique de Rééducation Fonctionnelle, Centre Hospitalier et Universitaire de Rennes, Hôpital Pontchaillou, France.
Arch Phys Med Rehabil. 1998 Jun;79(6):715-7. doi: 10.1016/s0003-9993(98)90050-8.
Detrusor-sphincter dyssynergia is an involuntary contraction of the external urethral sphincter during the detrusor contraction. It causes voiding dysfunction and can lead to urologic complications such as hydroureteronephrosis and renal failure. Patients with spinal cord injuries are particularly vulnerable. Botulinum toxin has been used via cystoscopy to decrease the activity of the external urethral sphincter. This report describes the treatment of 5 tetraplegic patients by single transperineal injections of botulinum toxin for detrusor-sphincter dyssynergia, proved by a urodynamic study with electromyography. A total of 15 injections was given, resulting in improved bladder function in all patients. Urodynamic assessment after treatment showed an increase of the functional detrusor capacity and a decrease of the maximal detrusor pressure during voiding. These results confirm the consideration of botulinum toxin as a treatment for detrusor sphincter dyssynergia. A single transperineal injection is a valuable, less invasive treatment using a cystoscopic technique.
逼尿肌-括约肌协同失调是指在逼尿肌收缩时尿道外括约肌出现不自主收缩。它会导致排尿功能障碍，并可能引发诸如肾盂积水和肾衰竭等泌尿系统并发症。脊髓损伤患者尤其易患此病。肉毒杆菌毒素已通过膀胱镜检查用于降低尿道外括约肌的活性。本报告描述了通过经会阴单次注射肉毒杆菌毒素治疗5例四肢瘫痪患者的逼尿肌-括约肌协同失调情况，该诊断经尿动力学检查及肌电图证实。共进行了15次注射，所有患者的膀胱功能均得到改善。治疗后的尿动力学评估显示功能性逼尿肌容量增加，排尿时最大逼尿肌压力降低。这些结果证实了肉毒杆菌毒素可作为治疗逼尿肌-括约肌协同失调的一种方法。经会阴单次注射是一种采用膀胱镜技术的有价值且侵入性较小的治疗方法。
