膀胱内注射肉毒素A治疗女性膀胱过度活动症的疗效探讨

lntravesical injections of botulinum-A toxin for treating female overactive bladder

目的探讨膀胱内注射肉毒素A治疗女性膀胱过度活动症的疗效。方法经膀胱训练和抗胆碱能药物等常规治疗无效的女性膀胱过度活动症患者8例，年龄23-62岁，平均42岁。患者均有尿急、尿频、夜尿增多症状，无急迫性尿失禁。膀胱镜下将肉毒素A200U注射于膀胱逼尿肌内，散在注射20-30点，并在尿道括约肌注射4点以防止术后尿潴留。记录治疗前及治疗6周后的排尿日记、常规尿动力学检查结果和患者症状改善情况，进行疗效评价。结果8例患者治疗6周后，排尿日记显示日排尿次数由（12．2±2．4）次减至（7．5±2．2）次（P〈0．05），夜尿次数由（2．2土0．3）次减至（1．8土0．4）次（P〉0．05）。尿动力学检查初始尿意时膀胱容量由（132．5±32．8）ml增至（190．2±37．6）ml（P〉0．05），膀胱最大容量由（217．3±34．6）ml增至（320．6±27．4）ml（P〈0．05）。2例治疗前尿动力学检查具有逼尿肌不稳定表现患者，1例逼尿肌不稳定消失，另1例初次不稳定收缩时膀胱容量由126ml增加到194ml。8例患者均未出现尿潴留、尿失禁等排尿并发症及全身不良反应，均对治疗效果满意，疗效持续5-9个月。结论膀胱内注射肉毒素A是治疗女性膀胱过度活动症安全有效的手段。

Objective To investigate the efficacy of intravesical injection of botulinum-A toxin for treating female overactive bladder, Methods Eight women （average age 42 years, range 23 to 62） presented with urgency, frequency and nocturia without urgency incontinence were enrolled in this study. All patient had failed to treatment options such as anticholinergic drugs. Botulinum-A toxin 200 U was injected under cystoscopy guidance into detrusor muscle at 20-30 sites and external sphincter muscle at 4 sites to reduce the probability of post-treatment urinary retention. Bladder diary and urodynamic examination were assessed before and 6 weeks after the treatment. Results At 6 weeks post-treatment, daytime frequency decreased from 12.2±2.4 to 7.5±2.2 （P〈0.05）, nocturia decreased from 2.2±0.3 to 1.8±0.4（P〉0.05）, the bladder volume at first desire to void increased from （132.5±32.8）ml to （190.2±37.6）ml（P〉0.05）, and the maximal bladder capacity increased from （217.3±34.6）ml to （320.6±27.4）ml（P〈0.05）. Detrusor overactivity was eliminated in 1 of the 2 patients with idiopathic detrusor overactivity. The volume when the first uninhibited detrusor contraction occurred increased from 126 ml to 194 ml in the other patient. No urinary retention and stress incontinence was observed in the 8 patients. All patients were satisfied with the effect. The therapeutic effects lasted for 5 to 9 months. Conclusions Intravesical injection of botulinum-A toxin appears to be a safe treatment with clinical efficacy in overactive bladder.