經陰道超音波導引肉毒桿菌素尿道外括約肌注射應用於膀胱功能低下症之女性患者之治療成效

蔡正晏、鄒頡龍

中國醫藥大學附設醫院 泌尿部

The Efficacy of Transvaginal Ultrasound-guided BoNT-A External Sphincter Injection in Female Patients with Underactive Bladder Syndrome

Cheng-Yen Tsai, Chieh-Lung Chou   

Divisions of Urology, China Medical University Hospital, Taichung, Taiwan

Introduction: BoNT-A injection is an increasingly common treatment modality for groups of patients with voiding dysfunction. However, patients' outcomes after treatment and their satisfaction with treatment vary widely. Previous clinical data also showed that studies on the treatment of BoNT-A injection to the external sphincter were less able to obtain consistent results. As far as we know, most current treatments are direct injections of BoNT-A into the urethral muscle. Nevertheless, whether this practice can deliver the drug to the urethral sphincter blindly is still unknown. We believe that if all BoNT-A can be accurately injected into the urethral sphincter, the treatment effect and patient satisfaction will be further improved. We propose a new treatment method: to accurately identify the external urethral sphincter with ultrasound guidance and inject botulinum toxin into the external urethral sphincter in the real-time method.

Methods: This is a single-center prospective cohort study conducted at China Medical University Hospital, a tertiary medical center in Taichung, Taiwan. From December 2020 to September 2022, 12 patients were enrolled. We evaluated the condition of lower urinary tract syndrome with patient perception of bladder condition (PPBC), International Prostate Symptoms Score (IPSS), and the uroflowmetry, Post-void residual volume, Cystometry (CMG) and External sphincter electromyogram (EMG). We evaluated patients the day before surgery and one week after the BoNT-A injection. For the patients requiring self-catheterization, we recorded the number of times the patient required clean intermittent catheterization (CIC) per day. The surgical procedure was performed by a single surgeon (ECL Chou) using the BoNT-A(BOTOX^®, Allergan, Irvine, CA, USA) ultrasound-guided external sphincter injection.

Results: From December 2020 to September 2022, a total of 12 patients with a mean age of 56.5±16.7(range, 18-88) years were enrolled. The International Prostate Symptom Score (IPSS) before and after one week of management is 21.83 and 13.33, which were statistically different (p=0.002). And when we focus on the subjective feeling of the patient, the patient perception of bladder condition score (PPBC) and the quality of life on IPSS before and after one week of management were both statically different, too. There was no urinary tract infection (UTI), no persistent gross hematuria for more than two days, and no urethral hematoma. One patient (8.3%) complained of severe urge urinary incontinence that needed wearing pad after the external sphincter injection. In the seven patient who needs daily clean intermittent catheterization. The time of CIC before and after one week of external sphincter BoNT-A injection were 4 and 1.42, which were statistically different (p=0.019).

Conclusions: Transvaginal ultrasound-guided external sphincter injection is a safe, efficacy method to improve the lower urinary tract symptoms and reduce the number of CIC for the patient with underactive bladder syndrome.