同時注射A型肉毒桿菌毒素於尿道內括約肌及尿道外括約肌治療脊隨損傷男性患者之逼尿肌過動及逼尿肌括約肌協同失調

陳冠宇、陳順郎¹、黃玉慧²、王紹全、陳文榮、謝佐宜、楊旻鑫、宋文瑋

中山醫學大學附設醫院 ¹泌尿科，²復健醫學部

Concomitant Detrusor and External Urethral Sphincter Botulinum Toxin-A Injections in Male Spinal Cord Injury Patients with Detrusor Overactivity and Detrusor Sphincter Dyssynergia

Kuan-Yu Chen¹, Sung-Lang Chen¹, Yu-Hui Huang², Shao-Chuan Wang, Wen-Jung Chen, Tuzo-Yi Hsieh, Ming-Hsin Yang, Wen-Wei Sung

Divisions of Urology¹ and Department of Physical Medicine and Rehabilitation², Chung Shan Medical University Hospital, Taichung, Taiwan

Purpose: To investigated the effects of concomitant botulinum toxin-A (BoNT-A) into the detrusor and external sphincter muscle (EUS) in suprasacral spinal cord injured patients with detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD).

Materials and Methods: An open treatment trial with pre- and post-treatment evaluations for male suprasacral spinal cord injury patients (N=20) with neurogenic DO and DSD who emptied their bladder by reflex voiding and were unwilling to increase intermittent catheterization (IC) frequency. Cystoscopic guidance of 200U BoNT-A injections into to detrusor and 100U into EUS were applied. The urodynamic parameters, voiding diaries and quality of life scores using UDI-6 and IIQ-7 were compared.

Results: All participants experienced a significant mean reduction in maximal detrusor pressure and maximal urethral pressure profile, a mean significant increase in maximal cystometric bladder capacity statistically 12 weeks after concomitant injections. Bladder diaries demonstrated persistently increased spontaneous voided volume, but not increase of post void residual (PVR) ratio, daily CIC frequency and diaper pad use from baseline to 24 weeks. UDI-6 scores showed significantly improved at 4 and 12 weeks and IIQ-7 scores showed only improved at 12 weeks.

Conclusions: Concomitant detrusor and EUS BoNT-A injections may decrease detrusor and urethra pressure without increase PVR ratio and diaper pad use. For SCI patients with NDO and DSD who are unwilling or inconvenient to increase CIC frequency and want to preserve spontaneous voiding, this treatment may provide optional alternative.