•  
  •  
 

Rehabilitation Practice and Science

Translated Title

A型肉毒桿菌素同時注射於逼尿肌和外括約肌治療神經性膀胱功能障礙之個案報告

Abstract

Patients with spinal cord injury above the sacral level usually have spastic type neurogenic bladder dysfunction (NBD). Spastic NBD is usually manifested with detrusor overactivity and detrusor-external sphincter dyssynergia (DESD). Botulinum toxin type A (BoNT-A) injection has been used in treating spastic NBD for long time. This injection can be performed either on the detrusor (which needs an intermittent catheterization program and a greater decrease in intravesicle pressure) or on the external sphincter (which may cause urinary incontinence and a smaller decrease in intravesicle pressure). Here we present a SCI patient receiving a new injection method involving BoNT-A injection simultaneously to the detrusor and external sphincter. Video urodynamics (VUD) revealed elevated urethral pressure (max P urethral: 149 cmH_2O), detrusor overactivity, increased intravesicle pressure, and obvious DESD before injection. The patient was referred to the urology clinic for BoNT-A injection 2 years and 9 months after injury. We injected Botox (onabotulinumtoxinA) 200 U over the detrusor muscle and 100 U over the external sphincter. VUD after injection showed decreased intravesicle pressure and cystogram showed decreased bladder wall trabeculation. Sphincter EMG still showed DESD but the activity decreased with lower urethral pressure. After injection, this patient had increased bladder capacity and volume of self voiding with similar residual amount. The frequency of intermittent catheterization decreased in 3 months after injection. He was satisfied with this treatment with improved scores for the Overactive Bladder Symptom Score, the short-form Urogenital Distress Inventory-6, and the short-form Incontinence Impact Questionnaire-7.

Language

Traditional Chinese

First Page

153

Last Page

160

Download

Share

COinS