研究目的：評估以直腸超音波引導注射肉毒桿菌毒素於尿道外括約肌，以治療脊髓損傷病患併有逼尿肌尿道外括約肌失調之療效（detrusor external sphincter dyssynergia，DESD）。研究對象：18個脊髓損傷病患併有逼尿肌尿道外括約肌失調患者。研究方法：在直腸超音波引導下，找到位於攝護腺外方的尿道外刮約肌，在會陰部直接注射100單位的肉毒桿菌毒素（稀釋在2毫升的生理食鹽水）。注射前及注射後一個月，安排尿動力學檢查，並記錄病患之殘尿量，追蹤達六個月。統計分析方法：以paired t-test檢定治療前後的最大逼尿肌壓力、漏尿時膀胱內壓、、尿道壓力、整合式肌電圖、及殘尿量變化，是否有統計上的差異(P<0.05)。研究結果：尿動力學檢查結果方面，在整合式肌電圖及尿道壓力均有明顯變化(P<0.05)，但在最大逼尿肌壓力及漏尿時膀胱內壓並沒有明顯變化。病患的殘尿量有明顯改善，尤其在注射後的一個月及兩個月(p<.012)。結論：直腸超音波引導下，於會陰部直接注射肉毒桿菌毒素，可以有效減少病患的殘尿量。因為此方法不需要以膀胱內視鏡來進行，故可以由一般復健科醫師來執行，是方便有效的方法。
Objective: To evaluate the effects of a single, trans-rectal, ultrasound-guided (TRUS-guided) trans-perineal injection of botulinum toxin A (BoNT/A) to the external urethral sphincter (EUS) for treating detrusor external sphincter dyssynergia (DESD).Design: Descriptive study.Setting: Rehabilitation hospital affiliated with a medical university.Participants: Patients (N=18) with supra-sacral spinal cord injury who had DESD confirmed on video-urodynamic study.Interventions: A single dose of 100 units BoNT/A was applied into the external urethral sphincter via trans-rectal ultrasound-guided trans-perineal route injection.Main Outcome Measures: Maximal detrusor pressure, detrusor leak-point pressure, integrated electromyography, maximal pressure on static urethral pressure profilometry and post-voiding residuals. Results: There were significant reductions in integrated electromyography (EMG) (p =.008) and static (p=.012) and dynamic urethral pressure (p=.023), but not in detrusor pressure and detrusor leak-point pressure after treatment. Post-voiding residuals also significantly decreased in the 1st and 2nd month after treatment (p<.012). Conclusions: TRUS-guided trans-perineal injection of BoNT/A has beneficial effects in treating DESD.
