Adem Emrah COĞUPLUGİL, Bahadır TOPUZ, Sercan YİLMAZ, Murat ZOR, Mesut GÜRDAL

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

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.

Anahtar Kelimeler:

aşırı aktif mesane, dirençli, detrüsör içi onabotulinum toksinA enjeksiyonu

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

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,

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