減少急尿感的嚴重程度是影響膀胱過動症患者在接受肉毒桿菌素注射療效的最重要因子
張嘉峰，郭漢崇
花蓮慈濟醫院泌尿科
Reduction of urgency severity is the most important factor in the subjective therapeutic outcome of intravesical onabotulinumtoxina injection for overactive bladder
Jia-Fong Jhang, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
Purpose:
This study investigated the relationship between the subjective outcome assessment and objective parameters after intravesical onabotulinumtoxinA injection in patients with overactive bladder.
Materials and Methods:
A total of 77 patients with urodynamically confirmed detrusor overactivity were treated with intravesical injection of 100 U of onabotulinumtoxinA in 20 divided injections (5 U in 0.5 ml normal saline each) at different sites sparing the trigone. The primary end-point was the change in the Global Response Assessment (GRA) 3 months after treatment. All patients were monitored monthly after treatment for up to 6 months. Patients were divided into the successful and failed treatment groups according to the change in their GRA (≥ 2 and ≤ 1, respectively) 3 months after injection. The changes in voiding diary variables, Urgency Severity Score (USS), Overactive Bladder Symptom Score (OABSS), maximal bladder capacity (MBC), post-void residual (PVR) volume, and voiding efficiency (VE) were compared between groups at each time point
Results:
Overall, the USS and OABSS and MBC improved after treatment. Three months after BoNT-A injection, 49 (64%) patients reported an improvement in the GRA of 2 (n = 30) or 3 (n = 19). Six months after treatment only USS, OABSS, and urgency episodes showed significant difference between the groups. No significant difference in MBC, PVR or VE was noted between groups at 6 months.
Conclusion:
Subjective, successful treatment outcomes of intravesical onabotulinumtoxinA injection for treatment of overactive bladder were significantly associated with a reduction in USS and decreased urgency and urge urinary incontinence episodes.