PDF(Pubmed)
Abstract：
Introduction: Transurethral injections into the bladder wall with botulinum toxin are an established treatment for refractory overactive bladder or detrusor overactivity. With the current injection technique, an average of approx. 18% and up to 40% of botulinum toxin is injected next to the bladder wall, potentially causing reduced efficacy or non-response. The article aims to evaluate the reasons for incorrect injections and propose strategies for complete delivery of the entire botulinum toxin fluid into the bladder wall. Material and Methods: Unstructured literature search and narrative review of the literature. Results: Incorrect injection of botulinum toxin fluid next to the bladder wall is caused by pushing the injection needle too deep and through the bladder wall. Bladder wall thickness decreases with increasing bladder filling and has a thickness of less than 2 mm beyond 100 mL in healthy individuals. Ultrasound imaging of the bladder wall before botulinum toxin injection can verify bladder wall thickness in individual patients. Patient movements during the injection therapy increase the chance of incorrect placement of the needle tip. Conclusions: Based on the literature search, it is helpful and recommended to (1) perform pretreatment ultrasound imaging of the bladder to estimate bladder wall thickness and to adjust the injection depth accordingly, (2) fill the bladder as low as possible, ideally below 100 mL, (3) use short needles, ideally 2 mm, and (4) provide sufficient anesthesia and pain management to avoid patient movements during the injection therapy.
摘要：
简介：经尿道向膀胱壁注射肉毒杆菌毒素是难治性膀胱过度活动症或逼尿肌过度活动症的既定治疗方法。使用当前的注入技术，平均大约。18％和高达40％的肉毒杆菌毒素被注射到膀胱壁旁边，可能导致疗效降低或无应答。本文旨在评估不正确注射的原因，并提出将整个肉毒杆菌毒素液完全输送到膀胱壁的策略。材料与方法：非结构化文献检索和文献叙事综述。结果：在膀胱壁附近注射肉毒杆菌毒素液体的不正确是由于将注射针推得太深并穿过膀胱壁引起的。膀胱壁厚度随着膀胱充盈的增加而减小,并且在健康个体中具有小于2mm超过100mL的厚度。在肉毒杆菌毒素注射之前对膀胱壁进行超声成像可以验证个体患者的膀胱壁厚度。在注射治疗期间的患者运动增加了针尖不正确放置的机会。结论：在文献检索的基础上，这是有帮助的，建议（1）进行膀胱的预处理超声成像，以估计膀胱壁的厚度，并相应地调整注射深度，(2)尽可能低的填充膀胱，理想情况下低于100毫升，（3）使用短针，理想情况下2毫米，和(4)提供足够的麻醉和疼痛管理以避免患者在注射治疗期间的运动。
