摘要
目的评估尿道外括约肌A型肉毒毒素(BTX-A)注射联合骶神经调控术(SNM)治疗特发性非梗阻性尿潴留(INOUR)的疗效与安全性。方法选取2022年5月—2024年5月于郑州大学第一附属医院泌尿外科就诊的57例INOUR患者作为研究对象,根据患者在BTX-A注射后是否行SNM将其分为BTX组(n=30)和联合组(n=27),BTX组给予基础疗法联合尿道外括约肌BTX-A注射治疗,联合组在BTX组基础上联合SNM。比较两组患者术前基线期、术后1个月及术后6个月的连续3天排尿日记、生活质量评分(QoL)、残余尿量(PVR),术前及术后1个月的影像尿动力学检查结果,以及随访期间的并发症发生情况。结果术后1个月,两组患者每日平均排尿次数、PVR均较术前降低,每日平均排尿量和最大尿流率(MFR)均较术前升高,差异具有统计学意义(P<0.05)。两组术后1个月的排尿期最大逼尿肌压力与术前比较差异无统计学意义(P>0.05)。术后1个月,联合组的每日平均排尿次数、每日平均排尿量、PVR、QoL、MFR、膀胱顺应性(BC)、最大膀胱测压容量(MCC)均优于BTX组(P<0.05),且联合组的治疗成功率更高(88.9%vs.63.3%,P<0.05)。术后6个月,BTX组疗效回到术前基线期(各指标较术前基线期差异无统计学意义),而联合组疗效稳定(各指标较术后1个月差异无统计学意义,较术前基线期持续改善)。术后随访期间,BTX组和联合组的并发症发生率差异无统计学意义[43.3%(13/30)vs.48.1%(13/27),P>0.05]。结论尿道外括约肌BTX-A注射联合SNM可提高INOUR患者的短期疗效,能在术后6个月维持疗效,安全可靠。
Objective To evaluate the efficacy and safety of botulinum toxin A(BTX-A)injection into the external urethral sphincter in combination with sacral neuromodulation(SNM)for the treatment of idiopathic non-obstructive urinary retention(INOUR).Methods A total of 57 INOUR patients treated in our hospital during May 2022 and May 2024 were enrolled.Patients were divided into the BTX(n=30)and combined groups(n=27)according to whether they chose SNM after BTX-A injection.The baseline,postoperative 1-month and 6-month consecutive 3-day voiding diaries,quality of life score(QoL),and post-void residual(PVR),preoperative and postoperative 1-month urodynamic results,and postoperative complications were recorded and compared between the two groups.Results One month after surgery,the average number of voiding frequency per day and PVR were lower in both groups than those before surgery(P<0.05),while the average daily urine volume and maximum flow rate(MFR)were higher(P<0.05).There was no statistically significant difference between the maximum detrusor pressure during micturition in both groups before and after surgery(P>0.05).One month after surgery,the average number of voiding frequency per day,average daily urine volume,PVR,QoL,MFR,bladder compliance(BC),and maximum cystometric capacity(MCC)were better in the combined group than in the BTX group(P<0.05),and the efficiency was higher in the combined group(88.9%vs.63.3%,P<0.05).Six months after surgery,the efficacy of the BTX group returned to the baseline level with no statistically significant difference,whereas the efficacy of the combined group was stable(not different from the postoperative 1-month indicators,but better than the baseline level).During the follow-up,there was no difference in the incidence of complications between the BTX group and combined group[43.3%(13/30)vs.48.1%(13/27),P>0.05].Conclusion BTX-A injection into the external urethral sphincter combined with SNM improves the short-term outcomes of INOUR patients and maintains the efficacy 6 months postoperatively,which is a safe and reliable treatment option.
作者
曾勇坤
王庆伟
朱文
李子凯
徐硕
王钏宇
金科
ZENG Yongkun;WANG Qingwei;ZHU Wen;LI Zikai;XU Shuo;WANG Chuanyu;JIN Ke(Department of Urology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《现代泌尿外科杂志》
2025年第12期1069-1074,共6页
Journal of Modern Urology
基金
国家自然科学基金项目(No.82470806)。
关键词
排尿困难
排尿控制
特发性非梗阻性尿潴留
A型肉毒毒素
骶神经调控
dysuria
urinary control
idiopathic non-obstructive urinary retention
botulinum toxin A
sacral neuromodulation
