功能性障礙型排尿婦女之尿道括約肌電生理學檢查及尿道括約肌肉毒桿菌注射手術之療效

張天霖、郭漢崇

佛教花蓮慈濟醫院 泌尿部

Urethral sphincter electrophysiology study of female dysfunctional voiding and the effect on treatment outcome of urethral Botox injections

Tien-Lin Chang, Hann-Chorng Kuo

Department of Urology, Buddhist Tzu Chi Hospital, Hualien, Taiwan

Purpose: This study uses the lower urinary tract electrophysiology (EP) study to investigate the role of woman with dysfunctional voiding (DV) and therapeutic efficacy of urethral BoNT-A injections.

Materials and Methods: This study is a single-center, prospective study from Nov. 2020 to Nov. 2021. A total of 40 patients with DV and 16 patients with chronic interstitial cystitis or intrinsic sphincter deficiency (ISD) were enrolled. All enrolled DV patients with had received urethral Botox injection for four times. Video-urodynamic study for diagnosis was done before intervention and questionnaire were assessed before and after treatment. EP studies were also performed to all enrolled patients.

Results: A total of 56 women (40 with DV and 16 with chronic interstitial cystitis or ISD as control group) with a mean age of 54.3 ± 18.0 and 61.1 ± 14.7 years respectively were enrolled. There is higher detrusor pressure in DV group than in control group. Polyphasic motor unit potentials were detected in 65.0% of women with DV, which disclosed reinnervation. As there were only 18.8% in control group (p=0.001). After urethral Botox injection, there is significant improvement in cQmax at postoperative one month and three months compare to baseline in patients with denervation or reinnervation. The visual analogue scale of dysuria after urethral Botox injection revealed significant improvement at 1 month, 3 months, 6 months and 9 months compare to baseline in all DV patients.

Conclusion: There is a satisfactory outcome in women with DV after urethral Botox injection. In EP study, patient with DV had higher prevalence of reinnervation than control group and cQmax had improved after urethral Botox injection at the first month and the third month of following up.