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目的:观察膀胱逼尿肌注射A型肉毒毒素(BTX-A)治疗神经源性逼尿肌过度活动(NDO)伴尿失禁的疗效和安全性。方法:2012年6月~2015年2月采用膀胱镜下逼尿肌注射BTX-A 200U治疗NDO伴尿失禁患者137例,记录治疗前2周和治疗后4周、8周和12周尿失禁生命质量评分表(I-QOL)、平均每天尿失禁次数、尿失禁患者例数、平均每次排尿量(导尿+自然排尿)以及治疗前2周和治疗后12周储尿期膀胱逼尿肌最大压力(Pdet_(max))、膀胱顺应性(BC)、首次出现逼尿肌过度活动时膀胱容量(VFIDC)、逼尿肌过度活动(DO)发生率和DO持续时间,并记录治疗后不良事件。结果:治疗后4周、8周和12周,患者I-QOL、每天尿失禁次数、尿失禁患者例数和平均每次排尿量与基线数据比较,差异均有统计学意义(P<0.01)。平均I-QOL较基线增加94.29%,平均每天尿失禁次数减少75.00%,尿失禁患者例数由137例(100%)下降至92例(67.15%),平均每次排尿量增加92.19%。治疗后12周,患者平均Pdet_(max)较术前下降46.77%,BC增加60.57%,VFIDC增加60.78%,DO发生率由100%下降至69.34%,DO持续时间缩短64.49%。术后6例出现尿路感染。结论:膀胱逼尿肌注射BTX-A治疗NDO能降低Pdet_(max)和增加VFIDC,降低DO发生率,减少DO持续时间,且能提高NDO患者的生命质量。
Objective: To observe the efficacy and safety of detrusor injections of botulinum toxin type A (BTX-A) in the treatment of neurogenic detrusor over activity (NDO) with urinary incontinence. Methods: From June 2012 to February 2015, 137 patients with NDO with urinary incontinence underwent cystoscopic detrusor injection of BTX-A 200U were enrolled. Urinary incontinence was recorded 2 weeks before treatment and 4 weeks, 8 weeks and 12 weeks after treatment (I-QOL), the average number of incontinence cases per day, the number of patients with urinary incontinence, the average number of urinary incontinence (catheterization + spontaneous voiding), and bladder detrusor during the two weeks before and 12 weeks after treatment Muscle pressure (Pdet max), bladder compliance (BC), first time VFIDC, detrusor over activity (DO) and duration of DO were recorded, and after treatment Adverse events. Results: The I-QOL, the number of urinary incontinence cases, the number of patients with urinary incontinence and the average per urinary output at 4 weeks, 8 weeks and 12 weeks after treatment were significantly different from the baseline data (P <0.01) . The average I-QOL increased 94.29% from baseline, with an average of 75.00% reduction in the number of urinary incontinence cases per day. The number of cases of urinary incontinence decreased from 137 cases (100%) to 92 cases (67.15%) with an average of 92.19% increase in urine output. At 12 weeks after treatment, the average Pdet max decreased 46.77%, 60.57% and 60.78% respectively compared with preoperative values, while the incidence of DO decreased from 100% to 69.34% and the DO duration decreased 64.49%. Postoperative urinary tract infection occurred in 6 cases. Conclusion: Treating NDO with detrusor detrusor injection of BTX-A can decrease Pdet max and increase VFIDC, reduce the incidence of DO, decrease the duration of DO, and improve the quality of life of NDO patients.