Botulinum Toxin A for Overactive Bladder and Detrusor Muscle Overactivity in Patients With Parkinson's Disease and Multiple System Atrophy
Botulinum Toxin A for Overactive Bladder and Detrusor Muscle Overactivity in Patients With Parkinson's Disease and Multiple System Atrophy
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DOI：
10.1016/j.juro.2009.06.023
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发表时间：
2009-10-01
影响因子：
6.6
通讯作者：
Berardelli, Alfredo
中科院分区：
文献类型：
--
作者：
Giannantoni, Antonella;Rossi, Aroldo;Berardelli, Alfredo
目的：帕金森氏病和多系统萎缩患者常发生排尿障碍。我们调查的有效性和安全性A型肉毒杆菌毒素注射到逼尿肌中的帕金森氏病和多系统萎缩的患者有难治性膀胱过度活动症和逼尿肌overactivity.Materials和方法：所有参与者进行了临床和尿动力学评估，并完成了生活质量调查表A型肉毒杆菌毒素治疗前，1和3个月后。4例帕金森病患者和2例多系统萎缩患者入组研究。所有患者均在膀胱镜引导下接受200 U A型肉毒杆菌毒素注射到逼尿肌20个部位。结果指标为临床评估（排尿日记，包括日间和夜间尿频，以及尿急和急迫性尿失禁发作），尿动力学评估（包括逼尿肌非抑制性收缩的第一容积和最大压力，以及最大膀胱测压容量）和压力流量研究。注射A型肉毒毒素后1个月和3个月，所有患者报告日间和夜间排尿频率降低，生活质量评分改善。在5个月的随访中，没有患者再次发生尿急和急迫性尿失禁。尿动力学检查显示所有检测的尿功能变量均得到改善。治疗期间或治疗后未记录到全身副作用。所有患者排尿后残余尿量增加，仅在多系统萎缩的患者中需要间歇性导尿。我们在一个小样本研究中报告的新的有益效果鼓励了更大规模的试验，以证实A型肉毒杆菌毒素注射到逼尿肌中是一种有效和安全的治疗难治性膀胱过度活动症和逼尿肌过度活动症的方法。系统萎缩
Purpose: Urinary disturbances are common in patients with Parkinson's disease and multiple system atrophy. We investigated the effectiveness and safety of botulinum toxin type A injected into the detrusor muscle in patients with Parkinson's disease and multiple system atrophy who had refractory overactive bladder symptoms and detrusor overactivity.Materials and Methods: All participants underwent clinical and urodynamic assessment, and completed a quality of life questionnaire before botulinum toxin type A treatment, and 1 and 3 months thereafter. Four patients with Parkinson's disease and 2 with multiple system atrophy were enrolled in the study. All patients received 200 U botulinum toxin type A injected into the detrusor muscle at 20 sites under cystoscopic guidance at a single session on an inpatient basis. Outcome measures were clinical assessment (a voiding diary including daytime and nighttime urinary frequency, and episodes of urgency and urge urinary incontinence), urodynamic assessment (including first volume and maximum pressure of uninhibited detrusor contractions, and maximum cystometric capacity) and pressure flow studies.Results: One and 3 months after botulinum toxin type A injection all patients reported that daytime and nighttime urinary frequency had decreased and quality of life scores improved. No patients had further episodes of urgency and urge urinary incontinence during the 5-month followup. Urodynamics showed improvement in all urinary function variables tested. No systemic side effects were recorded during or after treatment. In all patients post-void urinary residual volume increased and intermittent catheterization was required only in those with multiple system atrophy.Conclusions: The new beneficial effect that we report in a small study sample encourages larger trials to confirm botulinum toxin type A injection into the detrusor muscle as an effective and safe treatment for refractory overactive bladder symptoms and detrusor overactivity related to Parkinson's disease and multiple system atrophy.