MESANE PATOLOJİLERİNDE BOTULİNUM TOKSİN UYGULAMALARI: İLK HASTA SERİSİ SONUÇLARIMIZ

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.

Anahtar Kelimeler:

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

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