Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in thi...Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.展开更多
The aim of this study was to determine whether the lower urinary tract storage symptoms of benign prostatic obstruction （BPO） could be completely resolved after plasmakinetic enucleation of the prostate （PKEP） and...The aim of this study was to determine whether the lower urinary tract storage symptoms of benign prostatic obstruction （BPO） could be completely resolved after plasmakinetic enucleation of the prostate （PKEP） and the possible predictors of persistent symptoms. Two hundred and sixty-seven cases of BPO performed PKEP from July 2008 to June 2009 were retrospectively analyzed. Five-year postoperative data were collected and compared with the preoperative data. According to the urodynamic results, the patients were divided into involuntary detrusor contraction （IDC） group （n = 95） and no IDC group （n = 172） preoperatively; the patients with IDC were divided into IDC-persistent group （n = 33） and IDC-resolved group （n = 62） after PKER The predictors of persistent IDC were analyzed. Compared with the preoperative data, the 5-year postoperative data showed that the IDC rate was lower （P --- 0.000）, Overactive Bladder Symptom Score （OABSS） was lower （P = 0.000）, maximum cystometric capacity （MCC） was larger （P= 0.000）, Prostate volume （PV） was smaller （P= 0.000）, and prostate-specific antigen （PSA） was lower （P= 0.000）. Compared with the no IDC group, the IDC group showed that the age was older （P = 0.016）, MCC was smaller （P = 0.004）, PSA was higher （P = 0.016）, and Chronic Inflammation rate was higher （P = 0.004）. Compared with IDC-resolved group after PKER IDC-persistent group showed that the age was older （P = 0.019）, MCC was smaller （P = 0.000）, PSA was higher （P = 0.013）, and Chronic Ihflammation rate was higher （P = 0.032）. The present study shows that the storage symptoms are still needed to be focused on after PKER The advanced patient age, MCC, PSA, and chronic inflammation may be the important clinical predictors of persistent IDC.展开更多
文摘Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.
文摘The aim of this study was to determine whether the lower urinary tract storage symptoms of benign prostatic obstruction （BPO） could be completely resolved after plasmakinetic enucleation of the prostate （PKEP） and the possible predictors of persistent symptoms. Two hundred and sixty-seven cases of BPO performed PKEP from July 2008 to June 2009 were retrospectively analyzed. Five-year postoperative data were collected and compared with the preoperative data. According to the urodynamic results, the patients were divided into involuntary detrusor contraction （IDC） group （n = 95） and no IDC group （n = 172） preoperatively; the patients with IDC were divided into IDC-persistent group （n = 33） and IDC-resolved group （n = 62） after PKER The predictors of persistent IDC were analyzed. Compared with the preoperative data, the 5-year postoperative data showed that the IDC rate was lower （P --- 0.000）, Overactive Bladder Symptom Score （OABSS） was lower （P = 0.000）, maximum cystometric capacity （MCC） was larger （P= 0.000）, Prostate volume （PV） was smaller （P= 0.000）, and prostate-specific antigen （PSA） was lower （P= 0.000）. Compared with the no IDC group, the IDC group showed that the age was older （P = 0.016）, MCC was smaller （P = 0.004）, PSA was higher （P = 0.016）, and Chronic Inflammation rate was higher （P = 0.004）. Compared with IDC-resolved group after PKER IDC-persistent group showed that the age was older （P = 0.019）, MCC was smaller （P = 0.000）, PSA was higher （P = 0.013）, and Chronic Ihflammation rate was higher （P = 0.032）. The present study shows that the storage symptoms are still needed to be focused on after PKER The advanced patient age, MCC, PSA, and chronic inflammation may be the important clinical predictors of persistent IDC.
