【摘要翻译】前列腺素E2和拟胆碱能药联合治疗逼尿肌活动低下

[文题]Prostaglandin E2 and bethanechol in combination for treating detrusor underactivity
前列腺素E2和拟胆碱能药联合治疗逼尿肌活动低下
[来源] British Journal of Urology.
[年、卷、期、页]2004. 93(1):89-93
[作者]HINDLEY, R. G.; BRIERLY, R. D.; THOMAS, P. J.
[原文摘要]
Abstract
OBJECTIVE: To test the hypothesis, in a prospective randomized double-blind study, that the combination of intravesical prostaglandin E2 (PGE2) and oral bethanechol chloride (BC) are additive or synergistic in improving bladder emptying, as they have been used alone for treating impaired detrusor contractility with little clinical benefit.

PATIENTS AND METHODS: Nineteen patients with detrusor underactivity (17 men and two women) were eligible and randomized to one of two treatments. All had postvoid residual urine volumes (PVR) consistently of > 300 mL, most being reliant on clean intermittent self-catheterization (CISC). The experimental treatment group (nine patients) received once-weekly intravesical PGE2 (1.5 mg in 20 mL 0.9% saline) plus BC 50 mg four times daily, for a total of 6 weeks. The second group of 10 patients received a once-weekly instillation of saline together with placebo tablets, again for 6 weeks.

RESULTS: Before treatment the median (interquartile range) PVR was 426 (405–480) mL for those receiving both drugs; this decreased to 325 (290–352) mL after completing the treatment (P < 0.015). In the placebo group the respective values were 576 (539–777) and 538 (350–775) mL (P = 0.09). Four of the patients receiving the active combination reported symptomatic improvement and were able to reduce the frequency of CISC.

CONCLUSION: Although there was evidence of a pharmacological effect, BC and PGE2 had a limited therapeutic effect compared with placebo. Whilst we would not recommend this treatment as routine, it may be considered for the occasional treatment of a patient with detrusor underactivity.
中文翻译:
目的:因为前列腺素E2 (PGE2)和氯贝胆碱(BC)单独使用治疗逼尿肌收缩受损有很少的临床作用, 故通过前瞻性随机双盲研究来验证膀胱内灌注前列腺素E2(PGE2)和口服氯贝胆碱(BC)联合治疗可增加或协同提高膀胱的排空的假设.
患者和方法:选择了19例逼尿肌活动低下患者(17例男性和2例女性)随机分成两个治疗组.所有的患者剩余尿量(PVR)一直大于300ml,大部分患者依靠间歇自行导尿(CISC).实验治疗组(9例患者)接受膀胱灌注前列腺素E2（1.5mg+20ml生理盐水,1次/周）加口服氯贝胆碱逼(50mg,4次/日)联合治疗逼尿肌收缩受损,共6周.对照组(10例患者)膀胱内灌注生理盐水(1次/周)加口服安慰剂(4次/日),共6周.
结果:联合治疗前,接受PGE2和BC治疗的患者中位数(四分位数间范围)PVR是426(405-480) ml;经治疗后,PVR下降325(290-352) ml (P < 0.015).而安慰剂组各自的值为576 (539–777) 和 538 (350–775) ml (P = 0.09).其中有4例接受联合治疗的患者报告下尿路症状得到改善并减少了CISC的次数.
结论:尽管PGE2和BC联合治疗可产生药理作用,但PGE2和BC联合治疗与对照组比较,治疗效果有限. PGE2和BC联合治疗逼尿肌活动低下可偶尔作用,但我们不推荐PGE2和BC联合治疗逼尿肌活动低下作为一种常规治疗方法.

个人短评:逼尿肌活动低下在临床中治疗是比较棘手的,传统的治疗方法是长期留置导尿管,间歇自行导尿或尿流改道术, 但这些治疗方法给患者日常生活带来不便，并易发生尿路感染等并发症。许多学者探讨了治疗逼尿肌活动低下的治疗.近年来，有报道使用电极植入骶神经神经调制法、自体背阔肌显微神经血管游离移植术，及遥控植入尿道内硅酮导管法等治疗逼尿肌收缩受损，这些治疗方法对逼尿肌收缩受损者短时间内有一定的疗效，但它们的长期疗效需要进一步观察。