Abstract：
OBJECTIVE: The negative impact on quality of life and the economic-related burden to the patient and the health care system associated with idiopathic overactive bladder (iOAB) is well-documented. Intradetrusor OnabotulinumtoxinA (BTN/A) injections are a well-used treatment modality for the management of overactive detrusor refractory to medical management, with well-documented efficacy and safety profiles. There is currently no best practice guideline for the administration of BTN/A for this procedure and historically the trigone of the bladder has been excluded from the injection paradigm given the risk of vesicoureteral reflux (VUR).
METHODS: A scoping review methodology was employed to assess available literature to evaluate current techniques used. There is emerging literature that the inclusion of the trigone may increase the efficacy of the procedure, while maintaining a similar adverse effect profile. Similar results could also be obtained by decreasing the number of injection sites. A scoping review was completed with systematic methodology using the Preferred Systematic Reviews and Meta Analyses extension for Scoping Review checklist. The search strategy looked to evaluate BTN/A and number of injection sites and the inclusion of the trigone in female patients with iOAB. Studies with male or neurogenic bladder only were excluded. Mixed studies were included. A specialist research librarian was engaged, with supervision from a functional urologist using a combination of MeSH and natural language terms. Two investigators independently reviewed the titles and abstracts.
RESULTS: Twelve articles were included and were published between 2005 and 2021. There was no evidence of VUR in any of the results. All but one study reported similar if not improved efficacy of trigone-inclusion. Lower number of injection sites had similar efficacy profiles to higher numbers of intradetrusor injections.
CONCLUSIONS: Further high-quality randomized control trials of trigone inclusion and reduction of injection sites are required. It is hoped that with further exploration of intraoperative methods for BTN/A injections, the development of universally accepted guidelines may optimize management and experiences for patients with iOAB.
METHODS: A scoping review methodology was employed to assess available literature to evaluate current techniques used. There is emerging literature that the inclusion of the trigone may increase the efficacy of the procedure, while maintaining a similar adverse effect profile. Similar results could also be obtained by decreasing the number of injection sites. A scoping review was completed with systematic methodology using the Preferred Systematic Reviews and Meta Analyses extension for Scoping Review checklist. The search strategy looked to evaluate BTN/A and number of injection sites and the inclusion of the trigone in female patients with iOAB. Studies with male or neurogenic bladder only were excluded. Mixed studies were included. A specialist research librarian was engaged, with supervision from a functional urologist using a combination of MeSH and natural language terms. Two investigators independently reviewed the titles and abstracts.
RESULTS: Twelve articles were included and were published between 2005 and 2021. There was no evidence of VUR in any of the results. All but one study reported similar if not improved efficacy of trigone-inclusion. Lower number of injection sites had similar efficacy profiles to higher numbers of intradetrusor injections.
CONCLUSIONS: Further high-quality randomized control trials of trigone inclusion and reduction of injection sites are required. It is hoped that with further exploration of intraoperative methods for BTN/A injections, the development of universally accepted guidelines may optimize management and experiences for patients with iOAB.
摘要：
目的：特发性膀胱过度活动症（iOAB）对患者生活质量的负面影响以及对患者和医疗保健系统的经济相关负担是有据可查的。逼尿肌内尿素中毒A（BTN/A）注射是一种广泛使用的治疗方式，用于治疗难以治疗的逼尿肌过度活跃，具有有据可查的疗效和安全性。目前尚无用于此程序的BTN/A给药的最佳实践指南，并且鉴于膀胱输尿管反流（VUR）的风险，从历史上看，膀胱三角区已被排除在注射范例之外。
方法：采用范围审查方法来评估现有文献，以评估当前使用的技术。有新出现的文献表明，包含三角骨可能会增加手术的疗效，同时保持类似的不良反应。通过减少注射部位的数量也可以获得类似的结果。使用系统范围审查清单的首选系统审查和Meta分析扩展，以系统方法完成了范围审查。搜索策略旨在评估BTN/A和注射部位的数量，并在iOAB女性患者中纳入三角。仅男性或神经源性膀胱的研究被排除。包括混合研究。一位专业研究图书馆员订婚了，在功能性泌尿科医生的监督下，结合使用MeSH和自然语言术语。两名研究人员独立审查了标题和摘要。
结果：包含了12篇文章，并在2005年至2021年之间发表。在任何结果中都没有VUR的证据。除一项研究外，所有研究都报告了类似的，如果没有改善的话。较低数量的注射部位与较高数量的逼尿肌内注射具有相似的功效曲线。
结论：需要进一步的高质量随机对照试验研究三酮包合物和减少注射部位。希望随着对BTN/A注射术中方法的进一步探索,普遍接受的指南的制定可以优化iOAB患者的管理和经验.
方法：采用范围审查方法来评估现有文献，以评估当前使用的技术。有新出现的文献表明，包含三角骨可能会增加手术的疗效，同时保持类似的不良反应。通过减少注射部位的数量也可以获得类似的结果。使用系统范围审查清单的首选系统审查和Meta分析扩展，以系统方法完成了范围审查。搜索策略旨在评估BTN/A和注射部位的数量，并在iOAB女性患者中纳入三角。仅男性或神经源性膀胱的研究被排除。包括混合研究。一位专业研究图书馆员订婚了，在功能性泌尿科医生的监督下，结合使用MeSH和自然语言术语。两名研究人员独立审查了标题和摘要。
结果：包含了12篇文章，并在2005年至2021年之间发表。在任何结果中都没有VUR的证据。除一项研究外，所有研究都报告了类似的，如果没有改善的话。较低数量的注射部位与较高数量的逼尿肌内注射具有相似的功效曲线。
结论：需要进一步的高质量随机对照试验研究三酮包合物和减少注射部位。希望随着对BTN/A注射术中方法的进一步探索,普遍接受的指南的制定可以优化iOAB患者的管理和经验.
