Medikal tedaviye dirençli aşırı aktif mesane tedavisinde detrüsör içi botulinum toksin enjeksiyonu

Year 2020, Volume: 12 Issue: 3, 187 - 191, 31.12.2020

Adem Emrah Coğuplugil , Bahadır Topuz , Sercan Yilmaz , Murat Zor , Mesut Gürdal

Abstract

Giriş: Bu çalışmada dirençli aşırı aktif mesane (AAM) hastalarında onabotulinumtoksin-A (BONTA) enjeksiyonu sonuçları sunulmaktadır.

Gereç ve Yöntemler: 2013-2018 yıllarında dirençli AAM nedeniyle BONTA uygulanan hastalar retrospektif olarak taranıp kaydedildi. En az iki antimuskarinik ilacı 3 ay süreyle kullanmış olmasına rağmen fayda görmeyen ya da yan etkilerini tolere edemeyen hastalar dirençli AAM olarak tanımlandı. Hastalara ürodinamik ve/veya klinik olarak AAM tanısı kondu. Preoperatif ve postoperatif 2 hafta, 3 ay ve 6 ayda idrar analizi ve kültürü, postvoid rezidü idrar (PVR) ölçümü ve işeme günlüğü ve /veya semptom skorları ile değerlendirme yapıldı. İyileşme, tam kuruluk sağlanması veya semptomlarda >%50 düzelme olarak belirlendi. Tüm yan etkiler kaydedildi.

Bulgular: 71 hastaya dirençli AAM tanısıyla detrüsör içi 100 Ü BONTA uygulandı. Ortalama hasta yaşı 33.5 idi (aralık: 21-86 yıl). İyileşme oranları üçüncü ayda %78.8 ve altıncı ayda %67.6 idi. Komplikasyonlar şu şekildeydi; yüksek PVR nedeniyle temiz aralıklı kateterizasyon (TAK, %12.6), mikroskobik geçici hematüri (%7.1) ve üriner enfeksiyon (%8.4). TAK başlanan hastaların tümünde 5 hafta içinde yüksek PVR değerleri normale döndü. Akut retansiyon ve sistemik yan etki görülmedi.

Sonuç: Dirençli AAM hastalarında detrüsör içi 100 Ü BONTA enjeksiyonu etkili ve düşük komplikasyon oranları ile güvenli bir yöntem olarak kullanılmaya devam etmektedir.

Keywords

aşırı aktif mesane, dirençli, detrüsör içi onabotulinum toksinA enjeksiyonu

Intradetrusor onabotulinumtoxin A injection for the treatment of overactive bladder resistant to medical therapy

Abstract

Objectives: To present the results of onabotulinumtoxin-A (BONTA) injections in patients with overactive bladder (OAB) resistant to medical therapy.
Material and Methods: Patients who underwent BONTA injection due to resistant OAB between 2013-2018 were included in this retrospective study. Patients who have used at least two different antimuscarinic drugs for 3 months and not improved or cannot tolerate side effects are identified as resistant OAB. The diagnosis of OAB was made by urodynamic study and/or by clinical findings. All patients were evaluated with urinalysis and urine culture, post-void residual urine measurement (PVR) and voiding diary, and/or symptom scores preoperatively and postoperatively at 2 weeks, 3 months and 6 months. Improvement was determined as continence or> 50% improvement in symptoms. All side effects were recorded.
Results: 71 resistant OAB patients underwent intradetrusor 100 U BONTA injection. Mean patient age was 33,5 years (range:21-86). Improvement rates were 78,8% at 3 months and 67,6% at 6 months. Complications were as follows; clean intermittent catheterization (CIC) due to high PVR (12,6%), microscopic transient hematuria (7,1%), and acute cystitis (8,4%). High PVR values returned to normal within 5 weeks in all patients who underwent CIC. Systemic side effects or acute urinary retention did not occur.
Conclusion: Intradetrusor injection of 100 U BONTA continues to be used as an effective and safe treatment method in patients with resistant OAB. 

Keywords

Botulinum toxin, intradetrusor injection, onabotulinumtoxin-A, overactive bladder, resistant

References

• Referans1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21(2):167‐178.
• Referans2. Gormley EA, Lightner DJ, Faraday M, Vasavada SP; American Urological Association; Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193(5):1572‐1580.
• Referans 3. Phé V, de Wachter S, Rouprêt M, Chartier-Kastler E. How to define a refractory idiopathic overactive bladder? Neurourol Urodyn. 2015;34(1):2‐11.
• Referans4. Nambiar AK, Bosch R, Cruz F, et al. EAU Guidelines on Assessment and Non-surgical Management of Urinary Incontinence. Eur Urol. 2018;73(4):596‐609.
• Referans5. Nitti VW, Dmochowski R, Herschorn S, et al. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol. 2013;189(6):2186‐2193.
• Referans . Onem K, Bayrak O, Demirtas A, et al. Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in T Turkish population. Neurourol Urodyn. 2018;37(1):263‐268.
• Referans7. Dmochowski R, Chapple C, Nitti VW, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010;184(6):2416‐2422.
• Referans8. Chermansky CJ, Chancellor MB. Use of Botulinum Toxin in Urologic Diseases. Urology. 2016;91:21‐32.
• Referans9. Tincello DG, Kenyon S, Abrams KR, et al. Botulinum toxin a versus placebo for refractory detrusor overactivity in women: a randomised blinded placebo-controlled trial of 240 women (the RELAX study). Eur Urol. 2012;62(3):507‐514.
• Referans10. Kuo HC. Will suburothelial injection of small dose of botulinum A toxin have similar therapeutic effects and less adverse events for refractory detrusor overactivity?. Urology. 2006;68(5):993‐998.
• Referans11. Jiang YH, Ong HL, Kuo HC. Predictive factors of adverse events after intravesical suburothelial onabotulinumtoxina injections for overactive bladder syndrome-A real-life practice of 290 cases in a single center. Neurourol Urodyn. 2017;36(1):142‐147.