使用尿道擴張術治療女性患者棘手的膀胱過動症
葉忠信1,2,江漢聲2
1新光醫院 泌尿科,外科部 2天主教輔仁大學 醫學系
The effect of urethral dilatation on intractable overactive bladder in female patients
Chung-Hsin Yeh1, 2, Han-Sun Chiang2
1Division of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
2School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
Purpose: In the era of BCG and newly-enhanced Neuromodulation for treating patients with intractable overactive bladder, we intend to evaluate the effect of urethral dilatation on such refractory condition contracted by female patients.
Material and Methods: Each prospective study had been conducted at different time span from December, 2004 till the end of 2017. Female patients with OAB who failed behavioral therapy and pharmacotherapy were defined as intractable OAB and enrolled in the study. Voiding diary, UFM, and CMG were performed before and after the procedure of urethral dilatation, and patients with Qmax less than 20ml/sec were excluded. Patients were randomized to Group A for real dilatation and Group B with catheter in situ only (sham). The procedure was done as the following timeline: urethral dilatation till 30F or 3F catheter left, lasting for 30 minutes each time, 3 times per week; the whole course of treatment was finished after 3 consecutive weeks. The therapeutic effect was evaluated one week and 3 months after the treatment in terms of patients’ satisfaction, voiding diary, and urodynamic parameters.
Results: In one sample, 38 patients completed the study. 63.2% of patients in Group A reported satisfaction at one week after the treatment and 47.4% at 3 months after the procedure, and the corresponding figures for Group B were 21.1% and 5.3 %. Based on the voiding diary, urgency and frequency improved significantly both at one week and 3 months after urethral dilatation; but the similar effect could not be reached in Group B. In Group A, patients with detrusor overactivity(DO) had higher percentage of “patients’ satisfaction” than those without DO both at one week and 3 months after the treatment.
Conclusion: Urethral dilatation may be a favorable alternative treatment for female patients with intractable OAB if BCG or neuromodulation is not available. The presence of pre-treatment DO seemed to foresee better therapeutic effect after urethral dilatation.