<strong>Objective:</strong> To evaluate the efficacy and safety of Combined detrusor and external urethral sphincter BTX-A injections for detrusor overactivity (DO) and detrusor external sphincter dyssyner...<strong>Objective:</strong> To evaluate the efficacy and safety of Combined detrusor and external urethral sphincter BTX-A injections for detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. <strong>Study Design:</strong> Prospective study. <strong>Methods:</strong> The study was carried out in 18 SCI patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) receiving Combined detrusor and external urethral sphincter BTX-A injections treatment. Contain 200 U botulinum toxin intradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD (PdetmaxDO-DESD), volume at first DO and DESD (VDO-DESD), maximum urethral closure pressure (MUCP), and Incontinence-Specific Quality-of-Life Instrument (I-QoL). Adverse events were recorded. <strong>Results:</strong> All patients experienced a significant mean reduction in PdetmaxDO-DESD (50.75%), maximum urethral closure pressure (26.34%) and a significant mean increase in VDO-DESD (63.00%) 12-weeks post-injection. Significant (p < 0.001) improvement in mean Incontinence-Specific Quality-of-Life Instrument was also found. No obvious adverse event and toxic effect was observed. <strong>Conclusion:</strong> Combined detrusor and external urethral sphincter BTX-A injections is a good choice for patients with DO and DESD secondary to spinal cord injury. It could not only protect the upper urinary tract but also improve quality of life.展开更多
目的:评价A型肉毒杆菌毒素(BTX-A)尿道外括约肌注射加巴氯芬口服治疗脊髓损伤后尿道外括约肌协同失调症(DESD)的临床效果。方法:尿流动力学检查证实脊髓损伤后DESD患者38例,男31例、女7例,平均年龄(36.5±17.8)岁。200 U BTX-A溶解...目的:评价A型肉毒杆菌毒素(BTX-A)尿道外括约肌注射加巴氯芬口服治疗脊髓损伤后尿道外括约肌协同失调症(DESD)的临床效果。方法:尿流动力学检查证实脊髓损伤后DESD患者38例,男31例、女7例,平均年龄(36.5±17.8)岁。200 U BTX-A溶解于8 ml生理盐水,使用尿道镜注射针分8点二平面注射于尿道外括约肌(1 ml/点)。术后第2日,随机选取12例患者(BTX-A+巴氯芬组)加服巴氯芬10 mg/次、3次/d,服用3个月,与另外26例患者作比较(BTX-A组)。4周后复查尿流动力学,随访2～9个月,比较治疗前后排尿症状、尿动力学检查结果的变化,并观察毒副作用。结果:治疗后1个月,膀胱贮尿和排尿功能有不同程度改善,最大尿流率、单次尿量、最大膀胱测压容积、膀胱顺应性增加,剩余尿量及充盈末逼尿肌压力下降,差异均有统计学意义(P<0.05)。BTX-A+巴氯芬组患者症状改善程度及膀胱顺应性明显优于单纯BTX-A组(P<0.05)。BTX-A+巴氯芬组有3例患者因出现神经系统不良反应而停药,其余患者无明显不良反应发生。结论:BTX-A注射加巴氯芬口服可以有效改善脊髓损伤后逼尿肌尿道外括约肌协同失调症患者的排尿障碍,长期疗效尚需进一步的随访观察。展开更多
Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20...Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.展开更多
Multiple sclerosis is a neuroinflammatory condition that can cause significant bladder dysfunction manifesting either as overactive bladder or impaired bladder emptying.Patients will often complain of urgency,frequenc...Multiple sclerosis is a neuroinflammatory condition that can cause significant bladder dysfunction manifesting either as overactive bladder or impaired bladder emptying.Patients will often complain of urgency,frequency,nocturia,urgency incontinence,hesitancy,straining to void,and incomplete bladder emptying.While these symptoms can be treated with pharmacologic agents,often patients will require more significant treatments.Patients should first be evaluated with urodynamics in order to adequately diagnose the pathologic condition causing their symptoms.These interventions include catheter use,injection of botulinum toxin,neuromodulation,urethral stenting,sphincterotomy,suprapubic catheter with bladder neck closure,bladder augmentation and urinary diversion.The purpose of this review is to examine the evidence supporting each of these treatment options so urologic providers can better provide for this unique and complex patient population.展开更多
逼尿肌和尿道括约肌注射A型肉毒毒素(botulinum toxin A, BTX-A)可以阻断神经肌肉接头处突触前传出神经的乙酰胆碱释放,抑制目标肌的收缩,改善膀胱压力和尿动力学参数,降低尿路感染发生率和提高生活质量。目前,BTX-A已被美国食品药品监...逼尿肌和尿道括约肌注射A型肉毒毒素(botulinum toxin A, BTX-A)可以阻断神经肌肉接头处突触前传出神经的乙酰胆碱释放,抑制目标肌的收缩,改善膀胱压力和尿动力学参数,降低尿路感染发生率和提高生活质量。目前,BTX-A已被美国食品药品监督管理局批准用于治疗神经源性逼尿肌过度活跃症和难治性膀胱过度活动症。最近BTX-A治疗逼尿肌-括约肌协调障碍的临床试验也报告了有希望的治疗效果。该文对上运动神经元损伤特别是大脑皮质和骶上脊髓损伤引起的神经源性逼尿肌过度活动和逼尿肌-括约肌协同失调的BTX-A注射治疗进行综述。展开更多
文摘<strong>Objective:</strong> To evaluate the efficacy and safety of Combined detrusor and external urethral sphincter BTX-A injections for detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. <strong>Study Design:</strong> Prospective study. <strong>Methods:</strong> The study was carried out in 18 SCI patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) receiving Combined detrusor and external urethral sphincter BTX-A injections treatment. Contain 200 U botulinum toxin intradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD (PdetmaxDO-DESD), volume at first DO and DESD (VDO-DESD), maximum urethral closure pressure (MUCP), and Incontinence-Specific Quality-of-Life Instrument (I-QoL). Adverse events were recorded. <strong>Results:</strong> All patients experienced a significant mean reduction in PdetmaxDO-DESD (50.75%), maximum urethral closure pressure (26.34%) and a significant mean increase in VDO-DESD (63.00%) 12-weeks post-injection. Significant (p < 0.001) improvement in mean Incontinence-Specific Quality-of-Life Instrument was also found. No obvious adverse event and toxic effect was observed. <strong>Conclusion:</strong> Combined detrusor and external urethral sphincter BTX-A injections is a good choice for patients with DO and DESD secondary to spinal cord injury. It could not only protect the upper urinary tract but also improve quality of life.
基金supported by the China Postdoctoral Science Foundation,No.2015M581120
文摘Tanshinone ⅡA, extracted from Salvia miltiorrhiza Bunge, exerts neuroprotective effects through its anti-inflammatory, anti-oxidative and anti-apoptotic properties. This study intravenously injected tanshinone ⅡA 20 mg/kg into rat models of spinal cord injury for 7 consecutive days. Results showed that tanshinone ⅡA could reduce the inflammation, edema as well as compensatory thickening of the bladder tissue, improve urodynamic parameters, attenuate secondary injury, and promote spinal cord regeneration. The number of hypertrophic and apoptotic dorsal root ganglion（L6–S1） cells was less after treatment with tanshinone ⅡA. The effects of tanshinone ⅡA were similar to intravenous injection of 30 mg/kg methylprednisolone. These findings suggested that tanshinone ⅡA improved functional recovery after spinal cord injury-induced lower urinary tract dysfunction by remodeling the spinal pathway involved in lower urinary tract control.
文摘Multiple sclerosis is a neuroinflammatory condition that can cause significant bladder dysfunction manifesting either as overactive bladder or impaired bladder emptying.Patients will often complain of urgency,frequency,nocturia,urgency incontinence,hesitancy,straining to void,and incomplete bladder emptying.While these symptoms can be treated with pharmacologic agents,often patients will require more significant treatments.Patients should first be evaluated with urodynamics in order to adequately diagnose the pathologic condition causing their symptoms.These interventions include catheter use,injection of botulinum toxin,neuromodulation,urethral stenting,sphincterotomy,suprapubic catheter with bladder neck closure,bladder augmentation and urinary diversion.The purpose of this review is to examine the evidence supporting each of these treatment options so urologic providers can better provide for this unique and complex patient population.
文摘逼尿肌和尿道括约肌注射A型肉毒毒素(botulinum toxin A, BTX-A)可以阻断神经肌肉接头处突触前传出神经的乙酰胆碱释放,抑制目标肌的收缩,改善膀胱压力和尿动力学参数,降低尿路感染发生率和提高生活质量。目前,BTX-A已被美国食品药品监督管理局批准用于治疗神经源性逼尿肌过度活跃症和难治性膀胱过度活动症。最近BTX-A治疗逼尿肌-括约肌协调障碍的临床试验也报告了有希望的治疗效果。该文对上运动神经元损伤特别是大脑皮质和骶上脊髓损伤引起的神经源性逼尿肌过度活动和逼尿肌-括约肌协同失调的BTX-A注射治疗进行综述。
