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首页> 外文期刊>Urology >Efficacy of botulinum-a toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary results.
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Efficacy of botulinum-a toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary results.

机译：肉毒杆菌毒素引起的逼尿肌反射亢进患儿肉毒杆菌毒素的功效：初步结果。

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OBJECTIVES: The established treatment of children with neurogenic bladder consists of the use of anticholinergic drugs, such as oxybutynin and tolterodine, and clean intermittent catheterization four or five times a day. If anticholinergic drugs and clean intermittent catheterization fail, surgery is often necessary. With the intent of avoiding surgery, we investigated the effect of botulinum-A toxin for treating detrusor hyperreflexia in this group of patients. METHODS: The subjects were 17 children (average age 10.8 years) who had detrusor hyperreflexia and were using clean intermittent catheterization four or five times a day. Urodynamic studies were followed by injection of 85 to 300 U of botulinum-A toxin into 30 to 40 sites in the detrusor muscle. Urodynamic follow-up was done 2 to 4 weeks after injection. RESULTS: The mean reflex volume increased by 112.1%, from 95.00 plus minus 34.54 mL (range 47 to 147) to 201.45 plus minus 68.57 mL (range 77 to 310) (P <0.005). The maximal bladder capacity increased by 56.5%, from 137.53 plus minus 59.96 mL (range 59 to 242) to 215.25 plus minus 96.36 mL (range 60 to 380) (P <0.005). The maximal detrusor pressure decreased by 32.6%, from 58.94 plus minus 32.32 cm H(2)O (range 19 to 149) to 39.75 plus minus 26.12 cm H(2)O (range 7 to 100) (P <0.005). Detrusor compliance increased by 121.6%, from 20.39 plus minus 26.5 mL/cm H(2)O (range 4.5 to 40) to 45.18 plus minus 45.4 mL/cm H(2)O (range 5.3 to 100) (P <0.01). CONCLUSIONS: Botulinum-A toxin injection into the hyperreflexive detrusor muscle seems to be very effective and might be a therapeutic alternative to anticholinergic drugs.
机译：目的：对神经源性膀胱患儿的既定治疗方法包括使用抗胆碱能药物，例如奥昔布宁和托特罗定，并每天清洁间歇性导管插入四到五次。如果抗胆碱能药物和干净的间歇性导尿失败，则通常需要进行手术。为了避免手术，我们调查了肉毒杆菌毒素在该组患者中治疗逼尿肌反射亢进的效果。方法：研究对象为17例儿童，平均年龄为10.8岁，患有逼尿肌反射亢进，每天使用清洁间歇性导尿管4至5次。尿动力学研究之后，将85至300U的肉毒杆菌A毒素注射至逼尿肌的30至40个部位。注射后2-4周进行尿动力学随访。结果：平均反射体积增加了112.1％，从95.00 +负34.54 mL（范围47至147）增加至201.45 +负68.57 mL（范围77至310）（P <0.005）。膀胱最大容量增加了56.5％，从137.53加减59.96 mL（范围59至242）增加到215.25加减96.36 mL（范围60至380）（P <0.005）。最大逼尿肌压力从58.94加负32.32 cm H（2）O（19至149）降低到39.75加减26.12 cm H（2）O（7至100）（P <0.005），降低了32.6％。逼尿肌顺应性从20.39 +负26.5 mL / cm H（2）O（范围4.5至40）增加到45.18 +负45.4 mL / cm H（2）O（范围5.3至100）增加121.6％（P <0.01） 。结论：向反射亢进的逼尿肌中注射肉毒杆菌毒素似乎是非常有效的，并且可能是抗胆碱能药物的治疗替代方法。

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