Nörojenik aşırı aktif detrüsöz tedavisinde intravezikal botulinum-A toksin enjeksiyonu: Bir olgu sunumu ve literatürün gözden geçirilmesi
Küçük Resim Yok
Tarih
2005
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
45 yaşındaki erkek hasta, idrar-gaita inkontinansı ve alt ekstremitelerdeki kas güçsüzlüğü ile kliniğimize başvurdu. Hastada spinal perimedüller venlere drene olan dural arteriovenöz fistüle bağlı progresif myelopati saptandı. İlk ürodinamik incelemede maksimum sistometrik mesane kapasitesi 164 ml, maksimum detrüsör basıncı 50 cmH2O idi ve detrüsör-sfinkter dissinerjisi mevcuttu. Aralıklı kateterizasyon ile birlikte oksibutinin klorid 10 mg/gün dozunda başlandı. Bir yıl sonra, bu doz kontinensi sağlamada yetersiz olduğu için 15 mg/gün’e artırıldı. Ancak, hastanın ağız kuruluğu sorunu olduğu için, tolterodin 4 mg/gün’e değiştirildi. Hasta bir yıl sonra bu tedaviye yetersiz yanıt gösterdi. Kateterizasyonlar arasında inkontinans epizodları devam etmekteydi ve detrüsör aşırı aktivitesi vardı. İnkontinans antikolinerjik tedaviye direnç gösterdiği için, hastanın detrüsör kasına botulinum toksin-A uygulanmasına karar verildi. Detrüsör kasın, 30 bölgesine fleksibl 6 Fr enjeksiyon iğnesi ile toplam 300 ünite botulinum-A toksini enjekte edildi. Enjeksiyondan 4 ay sonra yapılan ürodinamik incelemede, maksimum sistometrik mesane kapasitesin 108 ml’den 250 ml’ye arttığı, maksimum detrüsör basıncının ise 63 cmH2O’dan 35 cmH2O’ya düştüğü saptandı.
A 45-year-old man applied to our department with the complaints of urinary and faecal incontinence and muscle weakness in the lower limbs. He had progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins.In the first urodynamic examination, maximum cystometric bladder capacity was 164 ml and maximum detrusor pressure was 50 cmH2O with detrusor-sphincter dyssinergia. Intermittent self-catheterization and oxybutynin chloride 10 mg daily was started. One year later, it was increased to 15 mg daily as it was ineffective to achieve continence. As the patient had a problem of dry mouth, it was changed to tolterodine 4 mg daily. The patient showed inadequate response to this treatment one year later. He still had detrusor overactivity and incontinence episodes between intermittent catheterisations. Botulinum-A toxin injection into the detrusor muscle of this patient was decided as the incontinence was resistant to anticholinergic therapy. A total of 300 units of botulinum-A toxin were injected with a custom made 6 Fr flexible injection needle at 30 detrusor muscle sites. Urodynamic examination which was done 4 months after the injection revealed that maximum cystometric bladder capacity increased from 108 to 250 ml and maximum detrusor pressure decreased from 63 to 35 cmH2O
A 45-year-old man applied to our department with the complaints of urinary and faecal incontinence and muscle weakness in the lower limbs. He had progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins.In the first urodynamic examination, maximum cystometric bladder capacity was 164 ml and maximum detrusor pressure was 50 cmH2O with detrusor-sphincter dyssinergia. Intermittent self-catheterization and oxybutynin chloride 10 mg daily was started. One year later, it was increased to 15 mg daily as it was ineffective to achieve continence. As the patient had a problem of dry mouth, it was changed to tolterodine 4 mg daily. The patient showed inadequate response to this treatment one year later. He still had detrusor overactivity and incontinence episodes between intermittent catheterisations. Botulinum-A toxin injection into the detrusor muscle of this patient was decided as the incontinence was resistant to anticholinergic therapy. A total of 300 units of botulinum-A toxin were injected with a custom made 6 Fr flexible injection needle at 30 detrusor muscle sites. Urodynamic examination which was done 4 months after the injection revealed that maximum cystometric bladder capacity increased from 108 to 250 ml and maximum detrusor pressure decreased from 63 to 35 cmH2O
Açıklama
Anahtar Kelimeler
Rehabilitasyon
Kaynak
Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
51
Sayı
3
