摘要目的:探讨A型肉毒毒素(BTX-A)膀胱壁注射治疗儿童难治性尿频尿失禁(UFI)的疗效和安全性，并分析预测BTX-A注射治疗效果的因素。方法:回顾性病例系列研究。分析2021年1月至2024年3月郑州大学第一附属医院收治的35例难治性UFI患儿的临床资料，男13例(37.1%)，女22例(62.9%)，年龄(12.3±4.2)岁。患儿均采用排尿基础疗法和药物治疗无效后接受BTX-A膀胱壁注射。分别于治疗前1周及治疗后3个月行尿动力学检查(UDS)，并收集膀胱过度活动症评分(OABSS)量表和尿失禁生活质量(I-QOL)评分量表。同时记录围术期和术后不良事件。术后3个月的总体反应评估(GRA)评分≥2被定义为治疗有效。根据术后GRA评分，将患儿分为治疗有效组和无效组，探讨影响BTX-A治疗效果的预测因素(如年龄、性别、术前尿动力参数以及尿失禁类型)。年龄、UDS各参数、OABSS和I-QOL评分等计量资料比较采用 t检验。性别、尿失禁类型等计数资料比较采用Fisher′s精确检验。 结果:BTX-A注射后的膀胱顺应性、膀胱容量比值、OABSS和I-QOL评分均有明显改善(均 P<0.05)。77.1%(27/35)的患儿对BTX-A效果满意。随访期间主要不良事件为注射后残余尿量一过性增加(7例)，均经过Creade动作或短暂清洁间歇导尿后缓解。治疗有效组(27例)和无效组(8例)比较，年龄[(13.00±4.32)岁比(10.00±2.67)岁]、术前膀胱顺应性[(11.21±5.74) mL/cmH 2O比(5.13±2.42) mL/cmH 2O]差异均有统计学意义( t＝2.383、2.899，均 P<0.05)；术前膀胱容量比值、充盈末逼尿肌压力、残余尿量、排尿效率、性别和尿失禁类型差异均无统计学意义(均 P>0.05)。 结论:BTX-A膀胱壁注射是一种治疗儿童难治性UFI安全有效的方法。治疗时年龄小和膀胱顺应性差是BTX-A治疗预后欠佳的相关因素。

abstractsObjective:To investigate the efficacy and safety of intravesical injections of botulinum toxin A (BTX-A) for the treatment of pediatric refractory urinary frequency and incontinence (UFI), and to analyze the factors predicting the therapeutic effect of BTX-A injections.Methods:A retrospective case series study was made on 35 children with UFI [(12.3±4.2) years old], including 13 males (37.1%) and 22 females (62.9%), treated in the First Affiliated Hospital of Zhengzhou University from January 2021 to March 2024.Urotherapy and drug treatments were ineffective in all children, who then received intravesical injections of BTX-A.The urodynamic study (UDS) was performed 1 week before treatment and 3 months after treatment, and the Overactive Bladder Symptom Score (OABSS) and Incontinence Quality of Life (I-QOL) were collected.Perioperative and postoperative adverse events were also recorded.A global response assessment (GRA) score of ≥2 at 3 months postoperatively was defined as effective treatment.According to the postoperative GRA score, the patients were divided into effective and ineffective groups to explore the predictive factors affecting the outcome of BTX-A treatment, such as age, gender, preoperative urodynamic parameters, and the types of urinary incontinence. t-test was used to compare quantitative data such as age, UDS parameters, OABSS, and I-QOL scores.The comparison of count data such as gender and urinary incontinence types was conducted using Fisher′s exact test. Results:The bladder compliance, bladder capacity ratio, OABSS and I-QOL scores of patients significantly improved after BTX-A injection (all P<0.05).The 77.1% (27/35) of the patients were satisfied with BTX-A treatment effects.The main adverse event during the follow-up was a temporary increase in postvoid residual urine after injecting BTX-A (7 cases), which was alleviated by the Creade action or clean intermittent catheterization.There was significant difference in age [(13.00±4.32) years vs.(10.00±2.67) years] and preoperative bladder compliance [(11.21±5.74) mL/cmH 2O vs.(5.13±2.42) mL/cmH 2O] between effective (27 cases) and ineffective groups (8 cases) ( t=2.383, 2.899, all P<0.05).The differences in preoperative bladder capacity ratio, maximum filling detrusor pressure, postvoid residual urine, voiding efficiency, gender, and the types of urinary incontinence were not statistically significant between the two groups (all P>0.05). Conclusions:Intravesical injection of BTX-A is a safe and effective treatment for children with refractory UFI.A young age and poor bladder compliance at treatment are associated with poor prognosis of BTX-A treatment.