Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI-RS 2019?
Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI-RS 2019?
复制标题
A 型肉毒杆菌毒素治疗难治性 OAB 和特发性尿潴留：表型分析能否改善患者的预后：ICI-RS 2019？
DOI：
10.1002/nau.24207
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发表时间：
2020
影响因子：
2
通讯作者：
Malde S
中科院分区：
文献类型：
--
作者：
Malde S
肉毒杆菌毒素A（BTX‐A）是治疗难治性特发性膀胱过度活动症（OAB）的一种成熟疗法。它也被用于治疗特发性尿潴留，并取得了短期成功。然而，疗效和并发症发生率是可变的，预测那些可能从治疗中获益最多的患者将使治疗个性化和结果优化。在2019年的国际咨询研究学会（ICI‐RS）会议上，一个智库解决了我们如何改善接受BTX‐A治疗的患者表型的问题。MethodsThe Think Tank进行了文献综述和专家共识会议，重点关注BTX‐A作用机制的基础科学研究进展，以及心理并发症的评估，可以转化为临床实践，以提高患者的选择therapy.ResultsIdiopathic OAB和特发性尿潴留是异质性的条件，包括多种表型与多种潜在的病理生理机制。动物模型已经证明了膀胱内注射BTX‐A的中枢神经系统作用机制，这已经在人类功能性MRI研究中得到证实，但该工具是否可以用于预测治疗结果仍有待确定。表型的基础上，心理comormalities使用验证筛选工具应研究作为一种方式，以潜在的优化患者选择therapeutic.ConclusionsAdvances在基础科学研究的作用机制BTX‐A提高了我们的理解的病理生理OAB，并可能导致新的方法表型患者。心理评估是另一种可以改善表型的方法。提出了进一步研究的领域。
AimsBotulinum toxin A (BTX‐A) is a well‐established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short‐term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence‐Research Society (ICI‐RS) meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX‐A treatment.MethodsThe Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX‐A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy.ResultsIdiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a central nervous system mechanism of action of intravesically injected BTX‐A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimize patient selection for therapy.ConclusionsAdvances in basic science research into the mechanism of action of BTX‐A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.