女性非神經性排尿功能障礙接受尿道括約肌肉毒桿菌毒素A注射之成功治療結果的影像尿動力學預測因子

郭漢崇¹、張天霖¹、楊家誠¹、江元宏¹、李雨霜¹、林琮翊¹、黃子修¹、劉民慶¹、游婉茹²、張嘉峰¹

佛教慈濟醫療財團法人花蓮慈濟醫院 泌尿部¹, 護理部²

Videourodynamic Predictive Factors for Successful Outcomes of Urethral Sphincter Botulinum Toxin A Injection in Women with Non-neurogenic Voiding Dysfunction

 Hann-Chorng Kuo¹, Tien-Lin Chang¹, Cia-Cheng Yang¹, Yuan-Hong Jiang¹, Yu-Shuang Lee¹, Tsung-Yi Lin¹, Tsu-Hsiu Huang¹, Ming-Ching Liu¹, Wan-Ru Yu², Jia-Fong Jhang¹

 ¹ Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan;

² Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

Purpose: Non-neurogenic voiding dysfunction is a urological condition characterized by difficult urination, slow stream, and/or incomplete bladder emptying. In women, the causes of voiding dysfunction include bladder neck dysfunction (BND), dysfunctional voiding (DV), detrusor underactivity (DU), and detrusor overactivity (DO) with DU. Urethral sphincter BoNT-A injection has been utilized for the treatment of neurogenic and non-neurogenic LUTD. This study retrospectively analyzed the treatment outcomes and videourodynamic predictive factors of successful outcomes of BoNT-A injection in women with non-neurogenic LUTD.

Materials and Methods: Urethral sphincter BoNT-A 100U was injected for women with non-neurogenic voiding dysfunction. All women had previous videourodynamic study (VUDS) and the pathophysiology of voiding dysfunction was identified. In total,100 U of BoNT-A was injected at 5 sites periurethrally in each patient. Treatment outcome was assessed according to the global response assessment (GRA) based on patients’ subjective report of voiding efficiency (VE) and difficulty in urination. The VUDS parameters were compared between treatment success (GRA=2 or 3) and failure groups (GRA= 0 or 1), and multivariate logistic regression was performed to find out predictive factors for a successful outcome.

Results: In total, 368 women received urethral BoNT-A injections. The mean age at injection was 54.1 ± 19.8 years. At 3months after urethral sphincter BoNT-A injection, 176 (47.8%) patients had a successful treatment outcome. Among them, 161 (91.5%) presented with DV and 15 (8.5%) with PRES. The successful rate was 65.4% (161/246) in patients with DV, 13.3% (15/112) in patients with PRES, how, none in patients with BND or DU. Previous history of TUI-BN was noted in 28 women (15.9%) of the successful treatment group, and in 57 (29.7%) of the failed treatment group (p = 0.002). Table 1 shows the VUDS findings and parameters between patients with successful and failed treatment outcomes. A successful outcome was noted in 161 (65.4%) of patients with DV and 15(13.4%) with PRES, with no successful outcomes in those with BND or DU. All VUDS parameters except VE significantly differed between the successful and failed treatment outcome groups. Based on the univariate logistic regression analysis, the predictive factors of successful outcome revealed that Pdet, Qmax, void volume, BOOI, and BCI were positively correlated with the treatment outcome. Meanwhile, FSF, FS, US, PVR, and CBC on VUDS were negatively correlated with the treatment outcome (Table 2). Pdet was a positive predictor for a successful outcome. In contrast, according to the multivariate logistic regression analysis, US and PVR were negative predictors.

Conclusion: This study showed that urethral sphincter BoNT-A injection is an effective treatment for non-neurogenic voiding dysfunction caused by DV in women, but not for PRES or BND. A higher Pdet and a smaller PVR at baseline could be predictors of a successful outcome in patients receiving urethral sphincter BoNT-A injections.