Transvaginal ultrasound guided trigone and bladder injection: A cadaveric feasibility study for a novel route of intradetrusor chemodenervation

Raveen Syan; Mason A. Briggs; John C. Olivas; Sakti Srivastava; Craig V. Comiter; Amy D. Dobberfuhl

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자료유형: 학술저널

저자정보: Raveen Syan (Stanford University School of Medicine) Mason A. Briggs (Stanford University School of Medicine) John C. Olivas (Stanford University School of Medicine) Sakti Srivastava (Stanford University School of Medicine) Craig V. Comiter (Stanford University School of Medicine) Amy D. Dobberfuhl (Stanford University School of Medicine)

저널정보: 대한비뇨기과학회 Investigative and Clinical Urology Investigative and Clinical Urology Vol.60 No.1

발행연도: 2019.1

수록면: 40 - 45 (6page)

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연구주제

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연구배경

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연구방법

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연구결과

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Purpose: OnabotulinumtoxinA (BTX) detrusor chemodenervation is an efficacious third-line treatment for overactive bladder. Despite high clinical efficacy rates for BTX injection, many patients refuse initial or repeat treatment due to the invasiveness of the cystoscopic route of delivery. We assess the feasibility of injecting the trigone and posterior bladder wall via a transvaginal route under ultrasound guidance using a human cadaveric model. Materials and Methods: Eight de-identified anonymous fresh female deceased donor cadaver pelvises were placed in supine split leg position. A transvaginal ultrasound probe guided injections of India ink into the trigone in 3 sites and the posterior wall in 2 sites. Full thickness bladder biopsies were then obtained and histologic analysis was performed to confirm presence of India ink in the detrusor layer. Results: The mean time from day of death was 11.0 days (range, 4.0–23.0 days). Three to five bladder biopsies were obtained per cadaver, for a total of 34 specimens (20 trigone, 14 posterior wall). Histologic analysis revealed presence of India ink within the detrusor layer in 8/8 (100.0%) of cadavers. The surgeon's perception of appropriate targeting under ultrasound guidance was confirmed in 8/8 cadavers (100.0%) involving the bladder trigone, and 7/8 (87.5%) involving the posterior wall. Of injections that were believed to have appropriately targeted the detrusor layer, 22/34 specimens (64.7%) demonstrated the presence of India ink under histologic analysis. Conclusions: Intradetrusor injection of the bladder trigone and posterior wall under transvaginal ultrasound guidance is feasible and has acceptable accuracy.

#Botulinum A toxin #Cadaver #Intravesical injection #Ultrasound imaging #Urinary bladder #overactive

참고문헌 (26)

참고문헌 신청

Sun Y / 2015 / The safety and efficiency of onabotulinumtoxinA for the treatment of overactive bladder: a systematic review and meta-analysis 47:1779~1788

Gormley EA / 2012 / Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline / J Urol 188(6 Suppl):2455~2463

Nitti VW / 2013 / OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence : results of a phase 3, randomized, placebo controlled trial / J Urol 189:2186~2193

Abdel-Meguid TA / 2010 / Botulinum toxin-A injections into neurogenic overactive bladder--to include or exclude the trigone? A prospective, randomized, controlled trial / J Urol 184:2423~2428

Kuo HC / 2011 / Bladder base/trigone injection is safe and as effective as bladder body injection of onabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics / Neurourol Urodyn 30:1242~1248

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