逼尿肌及尿道外括约肌A型肉毒毒素注射治疗儿童逼尿肌过度活动并收缩受损的疗效与安全性分析OA北大核心CSTPCD

Objective To assess the efficacy and safety of detrusor and external urethral sphincter injec-tions of botulinum toxin A in children with detrusor overactivity and impaired contractility(DOIC).Methods From May 2022 to June 2023,a total of 25 DOIC children received injections of botulinum toxin A in detrusor and external urethral sphincter.There were 18 boys and 7 girls with a mean age of(11.0±3.8)year.Three-day voiding diaries,quality of life questionnaires and incontinence-specific quality of life(I-QOL)assessments and overactive bladder symptom score(OABSS)were completed at baseline and Month 1/6.Also video-urody-namic examination at baseline and Month 1 and free uroflowmetry and residual urine measurement at baseline and Month 6 were performed.And the occurrences of adverse events were recorded.Results At baseline,mean urinary incontinence episode and daily voiding frequency were(6.9±1.5)and(10.8±1.7),quality of life questionnaire(8.8±0.7),OABSS(10.5±1.8),I-QOL score(43.6±4.6),mean voiding volume(127.4±37.9)ml,functional bladder capacity(FBC)(160.7±29.4)ml,maximum flow rate(MFR)(9.7 ±3.3)ml/s,mean daily frequency of catheterization(8.0±0.5),postvoid residual(PVR)(190.6±99.2)ml and bladder emptying efficiency(32.8±4.9)％in children undergoing intermittent catheterization(IC).At Month 1/6 post-injection,mean urinary incontinence episode and daily voiding frequency decreased to(3.5 ±1.3),(4.9±1.4)and(7.6±1.1),(8.5±1.4);quality of life questionnaire declined to(5.8±0.9),(7.1±0.8);OABSS score dropped to(8.5±1.0),(9.0±1.3);mean daily frequency of catheterization dipped to(6.4±0.7),(7.3±0.8),PVR decreased to(91.3±36.7),(121.9±42.7)ml;I-QOL score jumped to(59.7±5.8),(50.1±4.7);mean voiding volume increased to(164.9±31.1),(146.0±24.5)ml;FBC rose to(198.3±27.5),(176.2±24.3)ml;MFR spiked to(13.8±3.1),(11.0±2.5)ml/s;bladder emptying efficiency increased to(62.0±6.4),(47.8±6.7)％;Furthermore,the results of video-urodynamic examinations were compared between Month 1 and baseline.Maximum cystometric bladder capacity(MCC)(230.2±36.0 vs.198.2±46.1 ml)and bladder compliance(BC)(18.6±5.1 vs.14.4±6.6 ml/cmH2O)increased.In addition,maximal detrusor pressure(64.4±6.0 vs.80.0±5.1 cmH2O)and frequency of DO during bladder filling period(2.8±1.3 vs.4.4±1.7),maximum urethral pressure(MUP)(72.0±5.5 vs.78.5±8.2 cmH2O)and maximum urethral closure pressure(MUCP)(59.1±5.2 vs.64.1±7.2 cmH2O)all decreased.Among 4 children of vesicoureteral reflux(VUR)at baseline,there were resolution(n=2)and improvement(n=2)at Month 1;5/11 children of detrusor external sphincter dyssynergia(DESD)at baseline resolved at Month 1;2/7 children of detrusor bladder neck dyssynergia(DBND)at baseline resolved at Month 1.Furthermore,as compared with Month 1,mean urinary incontinence episode(4.9±1.4 vs.3.5±1.3)and daily voiding frequency(8.5±1.4 vs.7.6±1.1),quality of life questionnaire(7.1±0.8 vs.5.8±0.9),mean daily frequency of catheterization(7.3±0.8 vs.6.4±0.7)and PVR(121.9±42.7 vs.91.3±36.7 ml)increased while mean voiding volume(146.0±24.5 vs.164.9±31.1 ml),FBC(176.2±24.3 vs.198.3 ±27.5 ml),MFR(8.5±1.0 vs.10.5±1.8 ml/s),I-QOL score(8.5±1.0 vs 10.5±1.8)and bladder emptying efficiency(47.8±6.7％vs.62.0±6.4％)declined at Month 6(all P＜0.05).During follow-ups,there were transient gross in-catheter hematuria(n=7)and urinary tract infection(n=2).No other adverse e-vents occurred.Conclusions Injections of botulinum toxin A in detrusor and external urethral sphincter is an effective,mini-invasive and safe treatment for DOIC children.It may effectively improve the symptoms of abnor-mal urination and lower the risks of upper urinary tract injury.Moreover,quality of life improves after injections.Efficacy remains for at least 6 months.