肉毒桿菌毒素使用於神經性膀胱--- 病例報告
鄭鴻琳
國立成功大學 醫學院暨附設醫院 泌尿部
Application of Botulinum Toxin in the Neurogenic Bladder--- One Case Report
Hong-Lin Cheng
Department of Urology, Medical College and Hospital, National Cheng Kung University
Tainan, Taiwan
Purpose: The management of neurogenic bladder is based on keeping detrusor pressure at lower pressure to prevent renal damage and applying intermittent catheterization to empty bladder. The first line drug is anticholinergics. Although anticholinergics has some effect in this aspect, apparent side effects including dry mouth and constipation limit the willing of the use. Botulinum toxin type A, approved by U.S. FDA for the treatment of neurogenic bladder in adults in 2011, is an alternative to relax detrusor muscle. Herein, we report our experience.
Materials and Methods: This 20-year-old male presented with secondary nocturnal enuresis since senior high school at the age of 16 years, repeated acute pyelonephritis and back pain. He underwent spinal lipoma surgery at the age of 17 years. After spinal surgery, his videourodynamics revealed severe trabeculated bladder combined with decreased bladder compliance and with a small-sized bladder capacity. And then he received anticholinergics treatment and regular self intermittent urinary catheterization every 4 hours. However, his renal function deteriorated continually in 2-year follow-up
Results: He was conducted cystoscopic intravesical botulinum toxin type A injection under general anesthesia at the age of 20 years. A total of 200 U diluted to 20 ml in normal saline fluid was injected to detrusor muscle in 20 sites of posterior wall. Two weeks later, he felt bladder tightness improving and his follow-up renal function improved. After 2 months, cystometric capacity increased from 44 ml to 160 ml in videourodynamics.
Conclusion: From this case, for neurogenic bladder, intravesical botulinum toxin type A injection can effectively increase cystometric capacity.