Long-term Outcomes of Periurethral Sphincter Botulinum Toxin in Female Chronic Urinary Retention.

IF 1.8 3区医学 Q3 UROLOGY & NEPHROLOGY International Neurourology Journal Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.5213/inj.2448176.088

Sarah L Wright, Piriyankan Ananthavarathan, Sara Simeoni, Prasad Malladi, Mahreen Pakzad, Jalesh N Panicker

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Abstract

Purpose: Nonneurogenic chronic urinary retention is an uncommon problem in young female individuals, and a well characterised causes is Fowler syndrome (primary disorder of urethral sphincter relaxation). Intermittent catheterisation is often challenging, and gold standard treatment sacral neuromodulation is not widely available. Urethral sphincter botulinum toxin injection has been shown to be effective cross-sectionally, however little is known about long-term outcomes.

Methods: Female individuals presenting with urinary retention due to Fowler syndrome were reviewed retrospectively from a single tertiary referral centre over an 11-year period (2010-2021). One hundred units of onabotulinum toxin A (BoTX-A) was injected into the striated urethral sphincter in a divided dose by the periurethral approach. Efficacy and side effects were assessed 4 weeks after injection.

Results: Thirty-three female individuals with a mean age of 40.1±14.1 years received 165 unique urethral sphincter BoTX-A injections over 11 years. Nineteen individuals (57.6%) presented in acute urinary retention, and 28 (84.8%) were reliant on catheterisation. Twenty-one individuals (64%) responded to BoTX-A injections and had a significantly raised baseline maximum urethral closure pressure (MUCP), compared to nonresponders (114.6 cm H2O, P=0.012). Side effects were reported following 19 injections (11.5%) however, were mild and transient. Fifteen individuals received more than 1 botulinum toxin injection (median, 3 injections), with a median interval of 112 days (interquartile range) and efficacy persisted following repeat injections and no safety concerns were seen.

Conclusion: Sphincter botulinum toxin through the periurethral approach is safe and effective following repeat injections, and offers a low-cost, minimally invasive alternative to managing female chronic urinary retention due to Fowler syndrome, particularly when there was a high baseline MUCP.

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尿道周围括约肌肉毒杆菌毒素治疗女性慢性尿潴留的长期疗效。

目的：非神经源性慢性尿潴留在年轻女性中并不常见，其病因是福勒综合征（原发性尿道括约肌松弛障碍）。间歇性导尿通常具有挑战性，而金标准治疗方法骶神经调节术并不普及。尿道括约肌肉毒杆菌毒素注射已被证明具有横断面疗效，但对长期疗效却知之甚少：方法：对一家三级转诊中心 11 年间（2010-2021 年）因福勒综合征而出现尿潴留的女性患者进行回顾性研究。通过尿道周围注射法，将 100 单位的奥诺布林毒素 A（BoTX-A）分次注射到横纹尿道括约肌。注射 4 周后评估疗效和副作用：33 名平均年龄为 40.1±14.1 岁的女性在 11 年中接受了 165 次尿道括约肌 BoTX-A 注射。其中 19 人（57.6%）出现急性尿潴留，28 人（84.8%）依赖导尿。21 人（64%）对 BoTX-A 注射有反应，与无反应者相比，基线最大尿道闭合压 (MUCP) 明显升高（114.6 cm H2O，P=0.012）。据报告，注射 19 次（11.5%）后出现了副作用，但都是轻微和短暂的。15人接受了1次以上的肉毒毒素注射（中位数为3次），间隔时间中位数为112天（四分位间范围），重复注射后疗效持续，未发现安全问题：结论：通过尿道周围途径注射括约肌肉毒杆菌毒素既安全又有效，重复注射后疗效显著，是治疗福勒综合征所致女性慢性尿潴留的低成本、微创替代疗法，尤其是在基线 MUCP 较高的情况下。

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来源期刊

International Neurourology Journal UROLOGY & NEPHROLOGY-

CiteScore

4.40

自引率

21.70%

发文量

审稿时长

4 weeks

期刊介绍： The International Neurourology Journal (Int Neurourol J, INJ) is a quarterly international journal that publishes high-quality research papers that provide the most significant and promising achievements in the fields of clinical neurourology and fundamental science. Specifically, fundamental science includes the most influential research papers from all fields of science and technology, revolutionizing what physicians and researchers practicing the art of neurourology worldwide know. Thus, we welcome valuable basic research articles to introduce cutting-edge translational research of fundamental sciences to clinical neurourology. In the editorials, urologists will present their perspectives on these articles. The original mission statement of the INJ was published on October 12, 1997. INJ provides authors a fast review of their work and makes a decision in an average of three to four weeks of receiving submissions. If accepted, articles are posted online in fully citable form. Supplementary issues will be published interim to quarterlies, as necessary, to fully allow berth to accept and publish relevant articles.