MESANE PATOLOJİLERİNDE BOTULİNUM TOKSİN UYGULAMALARI: İLK HASTA SERİSİ SONUÇLARIMIZ

Year 2022, Volume: 55 Issue: 3, 200 - 202, 31.12.2022

Eda Tokat , Yildiray Yıldız

https://doi.org/10.20492/aeahtd.1188242

Abstract

AMAÇ: Botoks, Clostridium botulinum bakterisi tarafından üretilen güçlü bir nörotoksindir. Üroloji alanında nörojenik mesane, aşırı aktif mesane ve interstisyel sistit/mesane ağrı sendromu tedavisinde kullanılmaktadır. Biz de botulinum toksin uyguladığımız hastalarımızın verilerini paylaşmayı amaçladık.
GEREÇ VE YÖNTEM: Kliniğimizde 2018-2022 yılları arasında intravezikal botulinum toksin uygulaması yapılan toplam 42 hastanın verileri retrospektif olarak tarandı. Hastaların demografik verileri (yaş,cinsiyet,hastalık), geçmişte aldıkları tedavileri ve tedavi endikasyonları değerlendirildi. Hastaların botulinum toksin tedavi yanıtı, tedavi öncesi ve sonrası ortalama mesane kapasitesi ve tedavi fayda skalası (TFS; 1= çok iyileşme, 2= iyileşme 3= değişiklik yok, 4= kötüleşme) en erken 3. ayda değerlendirildi.
BULGULAR: Hastaların %38’i (16) erkek, %62’si (26) kadınlardan oluşurken ortalama yaşları 47.3 yıl (23-72) olarak bulundu. Botulinum toksin uygulanan hastaların, %66.7’si refrakter aşırı aktif mesane, %19’u nörojen mesane, %14.3’ü ise interstisyel sistit hastalarından oluşmaktaydı. Tüm hastalar en az iki farklı antikolinerjik kullanmıştı. Hastaların tedavi öncesi ortalama mesane kapasitesi 264.28 ml olarak hesaplandı. Tedavi sonrası en az 3 ay sonra yeniden yapılan işeme günlüğünde ortalama mesane kapasitesi 329.16 ml olarak hesaplandı (p=0.001). Hastalar tedaviden en az 3 ay sonraki kontrolde %64.2’si çok iyileşme (TFS= 1), %30.9’u iyileşme (TFS= 2) ve sadece %4.8’i şikayetlerinde değişiklik olmadığını (TFS= 3) belirtti. Hiçbir hasta şikayetlerinde kötüleşme (TFS= 4) bildirmedi.
SONUÇ: Medikal tedaviden fayda görmeyen AAM, interstisyel sistit ve nörojen mesane hastalarının ikinci basamak tedavisinde intravezikal botulinum toksin uygulaması faydalı, etkin, güvenli ve düşük maliyetli bir tedavi yöntemidir.

Keywords

Botulinum toksin, aşırı aktif mesane, interstisyel sistit, mesane ağrı sendromu, nörojenik mesane

Thanks

Çalışmada herhangi bir kişi, kurum ya da kuruluştan maddi destek sağlanmadı. Çalışmada herhangi bir çıkar çatışması bulunmamaktadır.

References

• 1. Simpson LL. Molecular pharmacology of botulinum toxin and tetanus toxin. Annual review of pharmacology and toxicology. 1986;26(1):427-453.
• 2. Smith CP, Gangitano DA, Munoz A ve ark. Botulinum toxin type A normalizes alterations in urothelial ATP and NO release induced by chronic spinal cord injury. Neurochemistry international. 2008;52(6):1068-1075.
• 3. Lucioni A, Bales GT, Lotan TL ve ark. Botulinum toxin type A inhibits sensory neuropeptide release in rat bladder models of acute injury and chronic inflammation. BJU international. 2008;101(3):366-370.
• 4. Chen J-L, Kuo H-C. Clinical application of intravesical botulinum toxin type A for overactive bladder and interstitial cystitis. Investigative and Clinical Urology. 2020;61(Suppl 1):S33-S42.
• 5. DUPONT MC, SPITSBERGEN JM, KIM KB ve ark. Histological and neurotrophic changes triggered by varying models of bladder inflammation. The Journal of urology. 2001;166(3):1111-1118.
• 6. Liu HT, Tyagi P, Chancellor MB ve ark. Urinary nerve growth factor but not prostaglandin E2 increases in patients with interstitial cystitis/bladder pain syndrome and detrusor overactivity. BJU international. 2010;106(11):1681-1685.
• 7. Giannantoni A, Conte A, Farfariello V ve ark. Onabotulinumtoxin-A intradetrusorial injections modulate bladder expression of NGF, TrkA, p75 and TRPV1 in patients with detrusor overactivity. Pharmacological Research. 2013;68(1):118-124.
• 8. Hutchinson A, Nesbitt A, Joshi A ve ark. Overactive bladder syndrome: Management and treatment options. Australian journal of general practice. 2020;49(9):593-598.
• 9. Haylen BT, De Ridder D, Freeman RM ve ark. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics: Official Journal of the International Continence Society. 2010;29(1):4-20.
• 10. Willis-Gray MG, Dieter AA, Geller EJ. Evaluation and management of overactive bladder: strategies for optimizing care. Research and Reports in Urology. 2016;8:113.
• 11. Corcos J, Przydacz M, Campeau L ve ark. CUA guideline on adult overactive bladder. Canadian Urological Association Journal. 2017;11(5):E142.
• 12. Hsu FC, Weeks CE, Selph SS ve ark. Updating the evidence on drugs to treat overactive bladder: a systematic review. International urogynecology journal. 2019;30(10):1603-1617.
• 13. Araklitis G, Thiagamoorthy G, Hunter J ve ark. Anticholinergic prescription: are healthcare professionals the real burden? International urogynecology journal. 2017;28(8):1249-1256.
• 14. Robinson D, Cardozo L. Managing overactive bladder. Climacteric. 2019;22(3):250-256.
• 15. Gormley EA, Lightner DJ, Faraday M ve ark. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. The Journal of urology. 2015;193(5):1572-1580.
• 16. Nambiar AK, Bosch R, Cruz F ve ark. EAU guidelines on assessment and nonsurgical management of urinary incontinence. European urology. 2018;73(4):596-609.
• 17. Nitti VW, Dmochowski R, Herschorn S ve ark. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. The Journal of urology. 2013;189(6):2186-2193.
• 18. Smith A, Bevan D, Douglas HR ve ark. Management of urinary incontinence in women: summary of updated NICE guidance. Bmj. 2013;347
• 19. Seth J, Dowson C, Khan M ve ark. Botulinum toxin-A for the treatment of overactive bladder: UK contributions. Journal of clinical urology. 2013;6(2):77-83.
• 20. Sukhu T, Kennelly MJ, Kurpad R. Sacral neuromodulation in overactive bladder: a review and current perspectives. Research and Reports in Urology. 2016;8:193.
• 21. Peters CA, Mandell J, Lebowitz RL ve ark. Congenital obstructed megaureters in early infancy: diagnosis and treatment. The Journal of urology. 1989;142(2):641-645.
• 22. Shie J-H, Liu H-T, Kuo H-C. Increased cell apoptosis of urothelium mediated by inflammation in interstitial cystitis/painful bladder syndrome. Urology. 2012;79(2):484. e7-484. e13.
• 23. Shea V, Cai R, Crepps B ve ark. Sensory fibers of the pelvic nerve innervating the rat's urinary bladder. Journal of neurophysiology. 2000;84(4):1924-1933.
• 24. Smith CP, Radziszewski P, Borkowski A ve ark. Botulinum toxin a has antinociceptive effects in treating interstitial cystitis. Urology. 2004;64(5):871-875.
• 25. Kuo HC, Chancellor MB. Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. BJU international. 2009;104(5):657-661.
• 26. Kuo H-C. Repeated onabotulinumtoxin-a injections provide better results than single injection in treatment of painful bladder syndrome. Pain physician. 2013;16(1):15-23.
• 27. Schurch B, De Seze M, Denys P ve ark. Botox Detrusor Hyperreflexia Study Team. Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol. 2005;174(1):196-200.
• 28. Fowler CJ, Griffiths D, De Groat WC. The neural control of micturition. Nature Reviews Neuroscience. 2008;9(6):453-466.
• 29. UK NCGC. Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease. 2012;
• 30. Stevens LA, Chapple CR, Chess-Williams R. Human idiopathic and neurogenic overactive bladders and the role of M2 muscarinic receptors in contraction. European urology. 2007;52(2):531-538.
• 31. Cooley LF, Kielb S. A review of botulinum toxin A for the treatment of neurogenic bladder. PM&R. 2019;11(2):192-200.
• 32. Dykstra DD, Sidi AA, Scott AB ve ark. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. The Journal of urology. 1988;139(5):919-922.
• 33. Martins-Silva C, Cruz F. Efficacy and safety of OnabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: Update of the pivotal randomised, double-blind, placebo-controlled trials. European urology focus. 2016;2(3):329-331.