多系统萎缩患者的尿动力学特点及临床应用

多系统萎缩（multiple system atrophy,MSA）是一种罕见的神经退行性疾病,早发的和突出的自主神经功能障碍是MSA的重要特征,而神经源性下尿路功能障碍（neurological lower urinary tract dysfunction,NLUTD）又是自主神经损伤的主要表现之一。尿动力学检查是评估NLUTD的可靠方法,不仅能够了解下尿路症状的病理生理机制,也能够发现MSA相对特异的尿动力学表现,在和帕金森病的鉴别诊断和预后评估方面有一定的应用价值。本文将结合MSA自主神经病变的特点对MSA患者尿动力学特点和临床应用进行综述。     

Botulinum Toxin Injections for Voiding Dysfunction Following SCI

Abstract

Botulinum toxin (BT) injections have been used successfully to treat spastic muscle conditions, including detrusor- sphincter dyssynergia (DSD) seen in spinal cord injury (SCI) patients. In our urology clinic, we used BT to treat three SCI patients who had voiding dysfunction, using a transperineal needle with electromyographic (EMG) monitoring. Two of the patients reported excellent results following the treatment. One patient, with whom the staff had difficulty doing intermittent catheterization (IC), improved significantly. The other patient had improved voiding with an external catheter and minimal urinary residual. The third patient had no improvement of leg spasms with his voiding dysfunction and required a sphincterotomy. Although patients may need repeat injections, BT is minimally invasive and easy to administer with no side effects. Overall, BT injection is an excellent method of managing voiding in SCI patients, especially those on continuous external catheters and with IC management who refuse or are not good candidates for surgery.     

Botox in Urology: A New Treatment Modality without Limitations?

Botulinum toxin is a presynaptic neuromuscular blocking agent inducing selective and reversible muscle weakness up to several months when injected intramuscularly in minute quantities. Different medical disciplines have discovered the toxin to treat mainly muscular hypercontraction. In urology, indications for botulinum-A toxin injections have been reported in detrusor-sphincter dyssynergia, chronic retention, chronic pelvic pain, begnin prostata hyperplasia, neurogenic detrusor overactivity and motor and sensory urinary urge incontinence. At this time, the use of botulinum-A toxin has still to be considered as an alternative treatment for it respective indications until large randomized controlled trials have proved their superiority to other therapies and long term benefit.     

钬激光外括约肌切开术治疗逼尿肌-外括约肌协同失调7例报道

目的探讨钬激光外括约肌切开术治疗逼尿肌-外括约肌协同失调（DSD）的技术方法、疗效和并发症。方法对7例接受钬激光外括约肌切开术的神经源性DSD男患者进行回顾性分析。结果术中及术后无1例患者需要输血。7例患者术后在症状学、实验室、影像学和尿动力学指标等方面均获得不同程度的改善。1例术后勃起功能受影响。所有患者无需再次手术。结论钬激光外括约肌切开术治疗DSD具有出血少、安全、疗效确切的优点,对有适应症的、经选择的患者不失为一好方法。     

网状尿道支架治疗神经原性下尿路功能障碍13例

目的：观察网状尿道支架植入术对神经原性下尿路功能障碍的治疗效果。方法：对13例神经原性下尿路功能障碍患者行网状尿道支架后尿道植入术，对比手术前后排尿功能、剩余尿量、肾积水程度、血清肌酐及尿素氮等指标的变化，评定手术对神经原性下尿路功能障碍的治疗效果。结果：13例患者中，7例术后能控制排尿，6例形成尿失禁，2例因术后不能耐受支架对尿道的刺激而取出支架，1例因术后仍存在排尿困难而行支架2次植入。所有患者的血清肌酐、尿素氮变化不明显，而剩余尿量和肾积水改善明显。结论：对神经原性下尿路功能障碍、逼尿肌-外括约肌协同失调患者，尿道支架植入术可显著减少残余尿量，改善肾盂积水状态。     

Contemporary management of lower urinary tract disease with botulinum toxin A: a systematic review of botox (onabotulinumtoxinA) and dysport (abobotulinumtoxinA)

Context

The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA).

Objective

To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children.

Evidence acquisition

We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence.

Evidence synthesis

There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis.

Conclusions

We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used.     

Voiding dysfunction associated with cervical spondylotic myelopathy

Patients with cervical spondylotic myelopathy who were neurosurgical candidates were prospectively evaluated for voiding abnormalities. The patients had relatively advanced neurologic disease because of delays in presentation and in diagnosis. The 22 consecutive patients included 20 males and 2 females with average age of 57 years. Sixteen patients had voiding symptoms with 12 noting a change in voiding pattern following the onset of their neurologic symptoms. Detrusor hyperreflexia was present in 16 (73%) of the patients and external sphincter dyssynergia in 8 (36%) of the patients. Neurologically mediated voiding dysfunction was common in patients with myelopathy secondary to cervical spondylosis.