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同時注射肉毒桿菌毒素於逼尿肌與尿道外括約肌對於脊髓損傷病患神經性膀胱功能障礙之先行療效研究

A Pilot Study of Concomitant Injection of Botulinum Toxin Type A in Detrusor and External Sphincter for Treatment of Neurogenic Bladder Dysfunction in Six Patients with Spinal Cord Injury

摘要


研究目的:本次研究以尿路動力學檢查(urodynamic study,UD)及臨床排尿記錄評估同時注射肉毒桿菌毒素於膀胱逼尿肌和尿道外括約肌對於脊髓損傷病患併有神經性膀胱功能障礙之療效。研究方法:本研究以前瞻性研究方式,收集有神經性膀胱功能障礙(合併有逼尿肌過動與尿道外括約肌共濟失調)之脊髓損傷病患,同時注射肉毒桿菌毒素於膀胱逼尿肌和尿道外括約肌,評估病患治療前及治療後一個月之排尿狀況和尿路動力學檢查結果。結果:本研究共納入6 位患者,在治療前後之排尿狀況有明顯改善:膀胱容量明顯增加(中位數360mlv.s. 490ml, p<0.05)、導尿量明顯增加(中位數240ml v.s. 290ml, p<0.05)、自解量增加但無顯著差異(中位數170ml v.s. 200ml, p>0.05)、導尿次數明顯降低(中位數4.8 次 v.s. 3.3 次, p<0.05);在治療前後之尿路動力學檢查也有明顯改善:最大膀胱壓明顯降低(中位數101cmH_20 v.s. 58cmH_20, p<0.05)、最大尿道壓明顯降低(中位數104cmH_20 v.s. 64cmH_20, p<0.05)、漏尿壓明顯降低(中位數83cmH_20 v.s. 42cmH_20, p<0.05)。結論:同時注射肉毒桿菌毒素於膀胱逼尿肌和尿道外括約肌後之脊髓損傷病患,在治療後一個月,可以明顯增加病患的膀胱容量並降低膀胱壓,且不會增加病患的導尿頻率,因此可以做為病患治療的另一種選擇。

並列摘要


Objective: This study examines clinical voiding records and urodynamic data to evaluate the therapeutic effects of concomitant botulinum toxin injections to the detrusor and external sphincter for the management of neurogenic bladder dysfunction in patients of spinal cord injury (SCI).Method: SCI patients with neurogenic bladder dysfunction who have both detrusor overactivity and detrusor external sphincter dyssynergia were recruited from a medical center in Central Taiwan. Six patients received concomitant injections of botulinum toxin to the detrusor and external sphincter. Their voiding records and urodynamic studies were compared between pre-treatment and one month post-treatment. Results: A total of 6 patients were recruited in the study. At one month after the injection, their bladder capacity (median: 360 ml vs. 490 ml, p<0.05) and catheterized volume significantly increased (median: 240 ml vs. 290 ml, p<0.05). The self-voiding volume also mildly increased but was not significantly different (median: 170 ml vs. 200 ml, p=0.068).The frequency of catheterization significantly decreased (median: 4.8 times vs. 3.3 times, p<0.05). The urodynamic studies showed significantly decreased pressure profiles after treatment. The comparisons of these pressure profiles before and after treatment included the maximal intravesical pressure (median: 101.00 cmH_20 vs. 58.00 cmH_20, p<0.05),maximal urethral pressure (median: 104.00 cmH20 vs. 63.50 cmH20, p<0.05), and leak point pressure (median: 83.00 cmH_20 vs. 41.50 mH_20, p<0.05). Conclusions: For patients with spinal cord injuries and neurogenic bladder dysfunction, the concomitant injection of botulinum toxin to the detrusor and external sphincter could increase bladder capacity and decrease intravesical pressure without increasing the frequency of catheterization. This treatment may be a good option for the selected patients.

參考文獻


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DeVivo MJ, Kartus PL, Stover SL, et al. Cause of death for patients with spinal cord injuries. Arch Intern Med 1989;149:1761-6.
Stover SL, DeVivo MJ, Go BK. History, implementation, and current status of the National Spinal Cord Injury Database. Arch Phys Med Rehabil 1999;80:1365-71.
Goldmark E, Niver B, Ginsberg DA. Neurogenic bladder: from diagnosis to management. Curr Urol Rep 2014;15:448.
Blaivas JG, Barbalias GA. Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition. J Urol 1984;131:91-4.

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