Patients with neurogenic lower urinary tract dysfunction (NLUTD) experience urinary incontinence with or without difficult urination, which might promote recurrent urinary tract infection (UTI) and exacerbate upper urinary tract function. Nonetheless, appropriate bladder management has been shown to reduce urological complications and improve quality of life. In addition to pharmacological therapy and surgical intervention, botulinum toxin A (BoNT-A) has been widely utilized in NLUTD. The therapeutic efficacy of detrusor BoNT-A injections for neurogenic detrusor overactivity due to spinal cord injury (SCI), multiple sclerosis, or other central nervous system lesions, such as cerebrovascular accident, Parkinson disease, early dementia, and pediatric NLUTD due to myelomeningocele, has been well established, with repeated BoNT-A injections every 6 to 9 months being necessary to maintain its therapeutic effects. Urethral BoNT-A injection can decrease urethral sphincter resistance and facilitate efficient voiding in patients with NLUTD who wish to preserve self-voiding. Detrusor BoNT-A injection can also decrease the occurrence of autonomic dysreflexia in patients with SCI, even after failed augmentation enterocystoplasty, with additional benefits including reduced UTI episodes and preserved renal function with repeated injections. However, this treatment does have some side effects. Complete informed consent for BoNT-A injection therapy with full disclosure of its potential complications should therefore be obtained before this procedure is undertaken.

中文翻译：

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肉毒杆菌毒素A在神经源性下尿路功能障碍治疗中的临床应用前沿。

具有神经源性下尿路功能障碍（NLUTD）的患者会出现尿失禁，伴有或不伴有排尿困难，这可能会促进复发性尿路感染（UTI）并加剧上尿路功能。尽管如此，已显示适当的膀胱处理可减少泌尿外科并发症并改善生活质量。除了药物治疗和外科手术干预以外，肉毒杆菌毒素A（BoNT-A）已广泛用于NLUTD。逼尿肌BoNT-A注射液对因脊髓损伤（SCI），多发性硬化或其他中枢神经系统病变（如脑血管意外，帕金森病，早期痴呆和脊髓灰质炎引起的小儿NLUTD）引起的神经源性逼尿肌过度活跃的治疗功效已经建立起来 为了维持治疗效果，必须每6至9个月重复注射BoNT-A。希望保留自我排泄功能的NLUTD患者，尿道内BoNT-A注射可以降低尿道括约肌抵抗力并促进有效排尿。注射逼尿肌BoNT-A还可减少SCI患者自主神经反射不良的发生，即使在增强肠囊成形术失败后，也具有其他好处，包括减少UTI发作次数和重复注射可保持肾功能。但是，这种治疗确实有一些副作用。因此，在进行此程序之前，应获得BoNT-A注射疗法的完全知情同意并充分披露其潜在并发症。希望保留自我排泄功能的NLUTD患者，尿道内BoNT-A注射可以降低尿道括约肌抵抗力并促进有效排尿。注射逼尿肌BoNT-A还可减少SCI患者自主神经反射不良的发生，即使在增强肠囊成形术失败后，也具有额外的好处，包括减少UTI发作和重复注射可保持肾功能。但是，这种治疗确实有一些副作用。因此，在进行此程序之前，应获得BoNT-A注射疗法的完全知情同意并充分披露其潜在并发症。希望保留自我排泄功能的NLUTD患者，尿道内BoNT-A注射可以降低尿道括约肌抵抗力并促进有效排尿。注射逼尿肌BoNT-A还可减少SCI患者自主神经反射不良的发生，即使在增强肠囊成形术失败后，也具有额外的好处，包括减少UTI发作和重复注射可保持肾功能。但是，这种治疗确实有一些副作用。因此，在进行此程序之前，应获得BoNT-A注射疗法的完全知情同意并充分披露其潜在并发症。注射逼尿肌BoNT-A还可减少SCI患者自主神经反射不良的发生，即使在增强肠囊成形术失败后，也具有额外的好处，包括减少UTI发作和重复注射可保持肾功能。但是，这种治疗确实有一些副作用。因此，在进行此程序之前，应获得BoNT-A注射疗法的完全知情同意并充分披露其潜在并发症。注射逼尿肌BoNT-A还可减少SCI患者自主神经反射不良的发生，即使在增强肠囊成形术失败后，也具有额外的好处，包括减少UTI发作和重复注射可保持肾功能。但是，这种治疗确实有一些副作用。因此，在进行此程序之前，应获得BoNT-A注射疗法的完全知情同意并充分披露其潜在并发症。