膀胱内毒素治疗膀胱过度活动症：如何最大程度地减少并发症并管理失败

Title:Intravesical Botox for Overactive Bladder: How to Minimize Complications and Manage Failures

Volume: 21 Issue: 15

关键词: 肉毒杆菌毒素，肉毒杆菌毒素A，肉毒杆菌，膀胱，逼尿肌，神经性，特发性，活动过度。

摘要: Intravesical Botox has become a widespread treatment for patients with refractory overactive bladder. Further to its acknowledged efficacy, both physicians and patients must be fully aware of possible complications, such as urinary tract infections, incomplete bladder emptying or even urinary retention and the possible need for intermittent self-catheterizations, fatigue, muscle weakness, transient hematuria and autonomic dysreflexia. Careful patient selection, particularly in terms of comorbidities, caution with technical aspects of the procedure such as the use of fine specifically designed injection needles, treatment of baseline UTIs or bacteriuria and avoidance of bladder overfilling could be the main measures, in addition to rigorous patient follow-up, to minimize the risk of post-Botox UTIs, hematuria, autonomic dysreflexia, and retention. Management of Botox failures is currently an unchartered area, starting with the definition of failure per se. Nevertheless, dose increase, particularly in neurogenic patients, increase of treatment frequency, switch to abobotulinumtoxinA, prolongation of injection intervals with add-on oral therapy, use of percutaneous tibial nerve stimulation or sacral neuromodulation and alleviation of risk factors for failure such as UTIs may be part of the management algorithm for Botox failures. As there is little evidence base to support such proposals and as the use of intravesical Botox is increasingly becoming a part of common urological practice, further research into the field of Botox failures and complications is needed so that both physicians and patients are granted with more solid, viable options.

Cite this article as:

Intravesical Botox for Overactive Bladder: How to Minimize Complications and Manage Failures, Current Drug Targets 2020; 21 (15) . https://dx.doi.org/10.2174/1389450121666200621194732