Botulinum toxin A for the Treatment of Overactive Bladder.
Botulinum toxin A for the Treatment of Overactive Bladder.
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DOI：
10.3390/toxins8030059
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发表时间：
2016-02-29
期刊：
影响因子：
4.2
通讯作者：
Chou EC
中科院分区：
文献类型：
--
作者：
Hsieh PF;Chiu HC;Chen KC;Chang CH;Chou EC
对膀胱过度活动症的标准治疗始于患者教育和行为治疗，然后是抗肉毒杆菌药物。目前，美国泌尿外科协会(AUA)和欧洲泌尿外科协会(EAU)的指南都建议，对于抗肉毒杆菌药物治疗无效的急迫性尿失禁患者，应该提供A型肉毒毒素膀胱内注射。A型肉毒毒素的作用机制包括抑制神经递质的囊泡释放，抑制辣椒素和嘌呤能受体在下丘脑的轴突表达，以及减弱中枢敏化作用。多项随机、安慰剂对照试验证明，A型肉毒毒素是治疗难治性特发性或神经源性逼尿肌过度活动患者的有效方法。与安慰剂相比，A型肉毒毒素对尿失禁发作、最大膀胱容量和最大逼尿肌压力的改善作用更大。肉毒杆菌毒素A的不良反应，如尿潴留和尿路感染，主要局限于下尿路。因此，A型肉毒毒素为顽固性膀胱过度活动症患者提供了一种有效的治疗选择。
The standard treatment for overactive bladder starts with patient education and behavior therapies, followed by antimuscarinic agents. For patients with urgency urinary incontinence refractory to antimuscarinic therapy, currently both American Urological Association (AUA) and European Association of Urology (EAU) guidelines suggested that intravesical injection of botulinum toxin A should be offered. The mechanism of botulinum toxin A includes inhibition of vesicular release of neurotransmitters and the axonal expression of capsaicin and purinergic receptors in the suburothelium, as well as attenuation of central sensitization. Multiple randomized, placebo-controlled trials demonstrated that botulinum toxin A to be an effective treatment for patients with refractory idiopathic or neurogenic detrusor overactivity. The urinary incontinence episodes, maximum cystometric capacity, and maximum detrusor pressure were improved greater by botulinum toxin A compared to placebo. The adverse effects of botulinum toxin A, such as urinary retention and urinary tract infection, were primarily localized to the lower urinary tract. Therefore, botulinum toxin A offers an effective treatment option for patients with refractory overactive bladder.