A型肉毒毒素治疗青少年难治性膀胱过度活动症的临床效果与安全性分析

Clinical efficacy and safety analysis of botulinum toxin type A in the treatment of refractory overactive bladder in adolescents

目的观察A型肉毒毒素治疗青少年难治性膀胱过度活动症的临床效果与安全性。方法选择2018年1月至2021年8月在浙江中医药大学附属杭州市第三人民医院泌尿外科就诊的27例难治性膀胱过度活动症青少年患者为研究对象。采用A型肉毒毒素膀胱内逼尿肌注射治疗(10 U/mL,平均分布注射20个点),并分别记录治疗前和治疗后1个月患者连续3 d的排尿日志和尿动力学参数变化情况。结果治疗后1个月患者日间排尿次数(11.72±7.41)次、平均单次排尿量(175.22±38.98)mL、夜间排尿次数(2.50±0.33)次、尿急次数(3.08±0.25)次、初始尿意时膀胱容量(154.86±42.54)mL、膀胱最大容量(350.22±61.13)mL,与治疗前相比均有所改善,其差异均具有统计学意义(均P<0.001)。首次治疗后,3例患者出现轻微血尿,2例患者出现尿路感染,其他患者无严重并发症或副作用。随访6~18个月,疗效持续2~8个月,失效后有8例患者经过再次注射治疗后症状缓解。结论对于传统药物治疗效果不佳的难治性膀胱过度活动症青少年患者,采用A型肉毒毒素能够安全有效地改善其下尿路症状,并显著提高其生活质量。

Objective To observe the clinical efficacy and safety of botulinum toxin A in the treatment of refractory overactive bladder in adolescents.Methods From January 2018 to August 2021,27 adolescent patients with refractory overactive bladder who were admitted to the Urology Department of Hangzhou Third People’s Hospital were analyzed retrospectively.Botulinum toxin Type A was injected into the detrusor muscle of the bladder(10 U/mL,with an average distribution of 20 points),and urination logs and changes of urodynamic parameters were recorded for 3 consecutive days before and 1 month after treatment.Results After treatment,the daily urination frequency(11.72±7.41),the mean urination volume(175.22±38.98)mL,the nocturia frequency(2.50±0.33),the frequency of urination urgency(3.08±0.25),the bladder capacity at initial urination(154.86±42.54)mL,the maximum bladder capacity(350.22±61.13)mL,compared with before treatment,the differences were statistically significant(all P<0.001).After the first treatment,3 patients developed mild hematuria,2 patients developed urinary tract infection,and the others had no serious complications or side effects.The patients were followed up for 6~18 months,and the curative effect lasted for 2~8 months.After failure,8 patients experienced symptomatic relief after reinjection therapy.Conclusions Botulinum toxin A can safely and effectively improve lower urinary tract symptoms and quality of life in patients with refractory overactive bladder disease who have not responded well to conventional therapy.