经尿道注射肉毒素A治疗逼尿肌反射亢进所致急迫性尿失禁

Urethral injection of botulinum toxin A in the treatment of urge urinary incontinence due to detrusor hyperreflexia

目的:探讨经膀胱镜局部注射肉毒素A治疗逼尿肌反射亢进导致的顽固性急迫性尿失禁的方法、有效性及不良反应。方法:选择2001-07/2005-08在昆明医学院第二附属医院确诊为逼尿肌反射亢进且保守治疗无效的急迫性尿失禁患者12例,患者知情同意,于麻醉下行经尿道逼尿肌内注射肉毒素A,每次剂量300U,分20个点注射。采用以患者为试验对象的自身对照试验方法,观察12例患者手术前及术后2个月的尿失禁频率、平均控尿时间、残余尿量、初尿意膀胱容量及膀胱最大容量,并对观察得到的各项数据进行两组间的配对t检验,同时观察有无肉毒素所致的不良反应发生。结果:12例患者均进入结果分析。①手术前后尿失禁频率平均值、平均控尿时间平均值、初尿意膀胱容量平均值、膀胱最大容量平均值差异有非常显著性眼穴13.83±2.72雪和穴4.17±2.08雪次/d,(0.60±0.22)和(1.42±0.40)h,穴68.75±17.34雪和穴122.50±20.50雪mL,穴102.50±13.57雪和穴207.50±47.12雪mL,P<0.001演。②手术前后残余尿量平均值无差异(P>0.05)。③术后无不良反应发生。结论:膀胱镜引导下逼尿肌内注射肉毒素A可明显改善急迫性尿失禁患者的临床症状,增强控尿能力,并且无不良事件发生,是一种微创、简便、有效而安全的治疗顽固性逼尿肌反射亢进的方法。

AIM： To evaluate the methods, efficacy and side effects of injecting botulinum toxin A under the guide of cystoscopy on urge urinary incontinence caused by detrusor hyperreflexia. METHODS： Totally 12 patients with urge urinary incontinence, who were diagnosed as detrusor hyperreflexia and ineffectively treated with expectant treatment at Second Affiliated Hospital of Kunming Medical College from July 2001 to August 2005, were selected as subjects. All of them agreed to join the experiment. The betulinum toxin A was injected into the detrusor under the guide of cystoscopy with the dose of 300 U every time at 20 points, respectively. Two months before and after operation frequency of urinary incontinence, mean continence urine time, residual urine volume （RUV）, first micturition desire bladder volume and maximum bladder capacity （MBC） were observed in 12 patients with own control. Each data were compared with paired t-test, at the same time, observing whether there were side effects induced by botulinum toxin A. RESULTS： A total of 12 patients were involved in the result analysis. ①The average value of the frequency of urinary incontinence, average value of mean continence times, average value of first desire volume and average value of MBC had significant difference before and after operation [（13.83±2.72） and （4.17±2.08） times per day, （0.60±0.22） and （1.42±0.40） hours, （68.75±17.34） and （122.50±20.50） mL,（102.50±13.57） and （207.50±47.12） mL,P 〈 0.001]. ②Average value of the residual volume before and after operation had no difference （P 〉 0.05）. ③There was no side effects after operation. CONCLUSION： Injecting botulinum toxin A into the detrusor under the guide of cystoscopy can effectively ameliorate clinical symptom of urge urinary incontinence caused by detrusor hyperreflexia, reinforce continence urine capacity, and there was no side effect, which is a kind of causing minimal injury, simple, effective and safe method in the treatment of refractory detrusor hyperreflexia.