Одним из проявлений нейрогенной дисфункции мочеиспускания у пациентов со спинномозговой травмой является гиперактивность мочевого пузыря. Она регистрируется в виде детрузорной гиперактивности, сочетающейся с детрузорно-сфинктерной диссинергией или без нее. Сегодня самым перспективным для купирования нейрогенной детрузорной гиперактивности признаны инъекции онаботулинотоксина в стенку мочевого пузыря. Этот метод рассматривается как высокоэффективный и малоинвазивный способ лечения. Он патогенетически обоснован, так как приводит к блокаде выработки ацетилхолина в пресинаптическую щель, что вызывает подавление парасимпатического влияния на детрузор. Авторы представляют современные положения о технологии инъекций онаботулинотоксина и эффективных дозах его применения. В статье освещены пер-спективные направления изменения технологии введения препаратов ботулинического токсина типа А.
Symptoms of the lower urinary tract are typical manifestations of spinal cord injury. One of the manifestations of neurogenic dysfunction of the lower urinary tract, observed in patients with spinal cord injury, is urinary bladder overactivity, which can be seen in combination with or without detrusor-sphincter dyssyner-gy. Currently, the most promising method of neurogenic bladder overactivity treatment is intravesical onabotulinumtoxin A injections. This method is considered is highly effective and minimally invasive. It is pathogenetically reasonable, since it leads to a blockade of acetylcholine production in the presynaptic gap, which causes a suppression of the parasympathetic effect on the detrusor. The authors present modern data of onabotulinum toxin injection technology and effective doses of its use. The article highlights promising changes in the technology of botulinum toxin type A administration.
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[Kogan M.I., Belousov I.I., Sizonov V.V. Primenenie botulinicheskogo toksina tipa A v korrektsii simptomov narushennogo mocheispuskaniia u detei i vzroslykh. Effektivnaia farmakoterapiia. 2011; 44: 10–5 (in Russian).]
8. Hu HZ, Granger N, Jeffery ND. Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury. J Vet Intern Med 2016; 30 (5): 1575–88.
9. Corcos J, Ginsberg D, Karsenty G. Textbook of the Neurogenic Bladder, 3rd Edition. Boca Raton, FL: CRC Press; 2015.
10. Кривобородов Г.Г., Колесанова Е.Ф., Тур Е.И., Ефремов Н.С. Фактор роста нервов в моче у больных с идиопатической детрузорной гиперактивностью и гиперактивным мочевым пузырем без детрузорной гиперактивности. Урология. 2015; 3: 19–23.
[Krivoborodov G.G., Kolesanova E.F., Tur E.I., Efremov N.S. Faktor rosta nervov v moche u bol'nykh s idiopaticheskoi detruzornoi giperaktivnost'iu i giperaktivnym mochevym puzyrem bez detruzornoi giperaktivnosti. Urologiia. 2015; 3: 19–23 (in Russian).]
11. Korzeniecka-Kozerska A, Wasilewska A. Urinary nerve growth factor in patients with detrusor overactivity. Ir J Med Sci 2015; 184 (4): 737–43. DOI: 10.1007/s11845-014-1162-8
12. Frias B, Santos J, Morgado M et al. The Role of Brain-Derived Neurotrophic Factor (BDNF) in the Development of Neurogenic Detrusor Overactivity (NDO). J Neurosci 2015; 35 (5): 2146–60. DOI: 10.1523/JNEUROSCI.0373-14.2015
13. Лопаткин Н.А., Салюков Р.В., Мартов А.Г. и др. Ботулинический токсин влечении функциональных нарушений мочеиспускания. Избранные лекции по урологии. Под ред. Н.А.Лопаткина, А.Г.Мартова. М.: Медицинское информационное агентство, 2008; с. 13–25.
[Lopatkin N.A., Saliukov R.V., Martov A.G. et al. Botulinum toxin in the treatment of functional disorders of urination. Selected lectures on urology. Pod red. N.A.Lopatkina, A.G.Martova. Moscow: Meditsinskoe informatsionnoe agentstvo, 2008; p. 13–25 (in Russian).]
14. Van Ermengem E. Ueber einen neuen anaeroben Bacillus und seine Beziehungen zum Botulismus. Z Hyg Infektionskr 1897; 26: 1–56.
15. Pirazzini M, Rossetto O, Eleopra R, Montecucco C. Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology. Pharmacol Rev 2017; 69 (2): 200–35.
16. Reitz A, Stöhrer M, Kramer G et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 2004; 45: 510.
17. Scott AB. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc 1981; 79: 734–70.
18. Dykstra DD, Sidi AA, Scott AB et al. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 1988; 139: 919–22.
19. Schurch B, Stöhrer M, Kramer G et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164: 692–7.
20. Apostolidis A, Rahnama'i MS, Fry C et al. Do we understand how botulinum toxin works and have we optimized the way it is administered to the bladder? Neurourol Urodyn 2016; 35 (2): 293–8. DOI: 10.1002/nau.22797
21. Linsenmeyer AT. Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review. J Spinal Cord Med 2013; 36 (5): 402–19. DOI: 10.1179/2045772313Y.0000000116
22. Cruz F, Herschorn S, Aliotta P, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol 2011; 60: 742–50.
23. Ginsberg D, Gousse A, Keppenne V et al Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol 2012; 187: 2131–9.
24. Moore DC, Cohn JA, Dmochowski RR. Use of Botulinum Toxin A in the Treatment of Lower Urinary Tract Disorders: A Review of the Literature. Toxins (Basel) 2016; 8: 88.
25. Liao CH, Chen SF, Kuo HC. Different number of intravesical onabotulinumtoxin A injections for patients with refractory detrusor overactivity do not affect treatment outcome: A prospective randomized comparative study. Neurourol Urodyn 2016; 35 (6): 717–23. DOI: 10.1002/nau.22780
26. Dasgupta P. Volume matters: bladder injections of botulinum toxin type A. Eur Urol 2012; 61: 1185–6.
27. Pinto R, Lopes T, Frias B et al. Trigonal injection of botulinum toxin A in patients with refractory bladder pain syndrome/interstitial cystitis. Eur Urol 2010; 58: 360–5.
28. Mascarenhas F, Cocuzza M, Gomes CM et al. Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients. Neurourol Urodyn 2008; 27 (4): 311–4.
29. Abdel-Meguid TA. Botulinum toxin-A injections into neurogenic overactive bladder--to include or exclude the trigone? A prospective, randomized, controlled trial. J Urol 2010; 184 (6): 2423–8. DOI: 10.1016/j.juro.2010.08.028
30. Zhou X, Yan HL, Cui YS et al. Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematicreview and meta-analysis. Chin Med J (Engl) 2015; 128: 963–8.
31. Soljanik I. Efficacy and safety of botulinum toxin A intradetrusor injectionsin adults with neurogenic detrusor overactivity/neurogenicoveractive bladder: a systematic review. Drugs 2013; 73 (10): 1055–66. DOI: 10.1007/s40265-013-0068-5
32. Weckx F, Tutolo M, De Ridder D, Van der Aa F. The role of botulinum toxin A in treating neurogenic bladder. Transl Androl Urol 2016; 5 (1): 63–71. DOI: 10.3978/j.issn.2223-4683.2016.01.10
33. Kuo HC. Comparison of effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity. J Urol 2007; 178 (4 Pt 1): 1359–63.
34. Šámal V, Mečl J, Šrám J. Submucosal administration of onabotulinumtoxinA in the treatment of neurogenic detrusor overactivity: pilot single-centre experience and comparison with standard injection into the detrusor. Urol Int 2013; 91 (4): 423–8. DOI: 10.1159/000350247
35. Chuang YC, Tyagi P, Huang CC et al. Urodynamic and immunohistochemical evaluation of intravesical botulinum toxin A delivery using liposomes. J Urol 2009; 182: 786–92.
36. Fougere RJ, Currie KD, Nigro MK et al. Reduction in Bladder-Related AutonomicDysreflexia after nabotulinumtoxinA Treatment in Spinal Cord Injury. J Neurotrauma 2016; 33: 1651–7.
37. Huang M, Chen H, Jiang C et al. Effects of botulinum toxin A injections in spinal cord injury patients with detrusor overactivity and detrusor sphincter dyssynergia. J Rehabil Med 2016; 48 (8): 683–7. DOI: 10.2340/16501977-2132
38. Jost WH, Benecke R, Hauschke D et al. Clinical and pharmacological properties of incobotulinumtoxinA and its use in neurological disorders. Drug Des Devel Ther 2015; 9: 1913–26.
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1. http://apps.who.int/iris/bitstream/handle/10665/94190/9789241564663_ eng.pdf; jsessionid=1C7062853B50B321A4687EB49E067BFC?sequence=1
2. Taweel W, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol 2015; 7: 85–99.
3. Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care 2013; 19 (10 Suppl.): s191–6.
4. Hoag N, Gani J. Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment. Int Neurourol J 2015; 19 (3): 185–9. DOI: 10.5213/inj.2015.19.3.185
5. Krivoborodov G.G., Efremov N.S. Methods for emptying the bladder. Moscow: e-noto, 2016; p. 32 (in Russian).
6. http://uroweb.org/wp-content/uploads/15-Neuro-Urology_2017_web.pdf
7. Kogan M.I., Belousov I.I., Sizonov V.V. Primenenie botulinicheskogo toksina tipa A v korrektsii simptomov narushennogo mocheispuskaniia u detei i vzroslykh. Effektivnaia farmakoterapiia. 2011; 44: 10–5 (in Russian).
8. Hu HZ, Granger N, Jeffery ND. Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury. J Vet Intern Med 2016; 30 (5): 1575–88.
9. Corcos J, Ginsberg D, Karsenty G. Textbook of the Neurogenic Bladder, 3rd Edition. Boca Raton, FL: CRC Press; 2015.
10. Krivoborodov G.G., Kolesanova E.F., Tur E.I., Efremov N.S. Faktor rosta nervov v moche u bol'nykh s idiopaticheskoi detruzornoi giperaktivnost'iu i giperaktivnym mochevym puzyrem bez detruzornoi giperaktivnosti. Urologiia. 2015; 3: 19–23 (in Russian).
11. Korzeniecka-Kozerska A, Wasilewska A. Urinary nerve growth factor in patients with detrusor overactivity. Ir J Med Sci 2015; 184 (4): 737–43. DOI: 10.1007/s11845-014-1162-8
12. Frias B, Santos J, Morgado M et al. The Role of Brain-Derived Neurotrophic Factor (BDNF) in the Development of Neurogenic Detrusor Overactivity (NDO). J Neurosci 2015; 35 (5): 2146–60. DOI: 10.1523/JNEUROSCI.0373-14.2015
13. Lopatkin N.A., Saliukov R.V., Martov A.G. et al. Botulinum toxin in the treatment of functional disorders of urination. Selected lectures on urology. Pod red. N.A.Lopatkina, A.G.Martova. Moscow: Meditsinskoe informatsionnoe agentstvo, 2008; p. 13–25 (in Russian).
14. Van Ermengem E. Ueber einen neuen anaeroben Bacillus und seine Beziehungen zum Botulismus. Z Hyg Infektionskr 1897; 26: 1–56.
15. Pirazzini M, Rossetto O, Eleopra R, Montecucco C. Botulinum Neurotoxins: Biology, Pharmacology, and Toxicology. Pharmacol Rev 2017; 69 (2): 200–35.
16. Reitz A, Stöhrer M, Kramer G et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 2004; 45: 510.
17. Scott AB. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc 1981; 79: 734–70.
18. Dykstra DD, Sidi AA, Scott AB et al. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 1988; 139: 919–22.
19. Schurch B, Stöhrer M, Kramer G et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164: 692–7.
20. Apostolidis A, Rahnama'i MS, Fry C et al. Do we understand how botulinum toxin works and have we optimized the way it is administered to the bladder? Neurourol Urodyn 2016; 35 (2): 293–8. DOI: 10.1002/nau.22797
21. Linsenmeyer AT. Use of botulinum toxin in individuals with neurogenic detrusor overactivity: State of the art review. J Spinal Cord Med 2013; 36 (5): 402–19. DOI: 10.1179/2045772313Y.0000000116
22. Cruz F, Herschorn S, Aliotta P, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol 2011; 60: 742–50.
23. Ginsberg D, Gousse A, Keppenne V et al Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol 2012; 187: 2131–9.
24. Moore DC, Cohn JA, Dmochowski RR. Use of Botulinum Toxin A in the Treatment of Lower Urinary Tract Disorders: A Review of the Literature. Toxins (Basel) 2016; 8: 88.
25. Liao CH, Chen SF, Kuo HC. Different number of intravesical onabotulinumtoxin A injections for patients with refractory detrusor overactivity do not affect treatment outcome: A prospective randomized comparative study. Neurourol Urodyn 2016; 35 (6): 717–23. DOI: 10.1002/nau.22780
26. Dasgupta P. Volume matters: bladder injections of botulinum toxin type A. Eur Urol 2012; 61: 1185–6.
27. Pinto R, Lopes T, Frias B et al. Trigonal injection of botulinum toxin A in patients with refractory bladder pain syndrome/interstitial cystitis. Eur Urol 2010; 58: 360–5.
28. Mascarenhas F, Cocuzza M, Gomes CM et al. Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients. Neurourol Urodyn 2008; 27 (4): 311–4.
29. Abdel-Meguid TA. Botulinum toxin-A injections into neurogenic overactive bladder--to include or exclude the trigone? A prospective, randomized, controlled trial. J Urol 2010; 184 (6): 2423–8. DOI: 10.1016/j.juro.2010.08.028
30. Zhou X, Yan HL, Cui YS et al. Efficacy and safety of onabotulinumtoxinA in treating neurogenic detrusor overactivity: a systematicreview and meta-analysis. Chin Med J (Engl) 2015; 128: 963–8.
31. Soljanik I. Efficacy and safety of botulinum toxin A intradetrusor injectionsin adults with neurogenic detrusor overactivity/neurogenicoveractive bladder: a systematic review. Drugs 2013; 73 (10): 1055–66. DOI: 10.1007/s40265-013-0068-5
32. Weckx F, Tutolo M, De Ridder D, Van der Aa F. The role of botulinum toxin A in treating neurogenic bladder. Transl Androl Urol 2016; 5 (1): 63–71. DOI: 10.3978/j.issn.2223-4683.2016.01.10
33. Kuo HC. Comparison of effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity. J Urol 2007; 178 (4 Pt 1): 1359–63.
34. Šámal V, Mečl J, Šrám J. Submucosal administration of onabotulinumtoxinA in the treatment of neurogenic detrusor overactivity: pilot single-centre experience and comparison with standard injection into the detrusor. Urol Int 2013; 91 (4): 423–8. DOI: 10.1159/000350247
35. Chuang YC, Tyagi P, Huang CC et al. Urodynamic and immunohistochemical evaluation of intravesical botulinum toxin A delivery using liposomes. J Urol 2009; 182: 786–92.
36. Fougere RJ, Currie KD, Nigro MK et al. Reduction in Bladder-Related AutonomicDysreflexia after nabotulinumtoxinA Treatment in Spinal Cord Injury. J Neurotrauma 2016; 33: 1651–7.
37. Huang M, Chen H, Jiang C et al. Effects of botulinum toxin A injections in spinal cord injury patients with detrusor overactivity and detrusor sphincter dyssynergia. J Rehabil Med 2016; 48 (8): 683–7. DOI: 10.2340/16501977-2132
38. Jost WH, Benecke R, Hauschke D et al. Clinical and pharmacological properties of incobotulinumtoxinA and its use in neurological disorders. Drug Des Devel Ther 2015; 9: 1913–26.
Авторы
Р.В. Салюков*1, А.С. Колмаков2, А.Г. Мартов3
1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 ФГАУ «Лечебный-реабилитационный центр» Минздрава России, Москва, Россия;
3 ФГБУ «Государственный научный центр Российской Федерации – Федеральный медицинский биофизический центр имени А.И. Бурназяна» ФМБА России, Москва, Россия
*salyukov2012@yandex.ru
________________________________________________
Roman V. Salyukov*1, Aleksandr S. Kolmakov2, Aleksei G. Martov3
1 People’s Friendship University of Russia, Moscow, Russia;
2 Therapeutic Rehabilitation Center, Moscow, Russia;
3 Burnazyan Federal Medical Biophysical Center, Moscow, Russia
*salyukov2012@yandex.ru