Gibt es eine systemische Muskelschwäche nach intravesikaler Botulinumtoxin-Behandlung? Eine Annäherung an ein uro-geriatrisches Problem

Zusammenfassung

Einleitung Eine Skelettmuskelschwäche nach Botulinumtoxin-Injektion in den Detrusor wird in Studien durch Patienten mit einer Häufigkeit von knapp 10 % angegeben. Dieses würde bei geriatrischen Patienten ggf. eine vorhandene Sturzneigung verschärfen. Ob sich tatsächlich eine Muskelschwäche nach urologischer Botulinumtoxin-Behandlung nachweisen lässt, soll erstmals mit einer geriatrischen Methodik (Handkraftmessung) objektiviert werden.

Material und Methode Messung der Handkraft (dominante Hand, Dokumentation des besten von 3 Messwerten, eine Schwäche wird bei einem Abfall von > 20 % angenommen) mit einem in der Geriatrie üblichen Ballon-Hand-Dynamometer in einem prospektiven Design vor und 3 Monate nach Gabe von Botulinumtoxin in einer Dosierung je nach Indikation von 100 – 200 MU. Es waren 100 konsekutive Patienten avisiert.

Ergebnisse Die Abnahme der Handkraft betrug nach einer Zwischenauswertung von 53 Patienten mit einem mittleren Alter von 65,25 ± 13,99 Jahren für alle Patienten +0,00 ± 0,06 kPa oder –0,13 ± 1,69 %. Sie betrug bei Patienten, die 100 MU Botulinumtoxin erhalten hatten +0,01 ± 0,06 kPa oder –0,29 ± 1,64 % und nach Injektion von 200 MU Botulinum –0,02 ± 0,06 kPa oder 0,720 ± 1,77 %. Die Veränderungen waren weder für das Gesamtkollektiv der Patienten noch für den Unterschied zwischen den beiden Dosisgruppen signifikant. Daraufhin wurde die Untersuchung vorzeitig beendet.

Schlussfolgerungen Die Resultate der erstmals durchgeführten Handkraftmessung nach intravesikaler Botulinumtoxin-Gabe zeigen, dass dosisunabhängig keine Handkraftschwäche als Indikator einer generalisierten Muskelschwäche entsteht. Dies lässt Botulinumtoxin bei der therapierefraktären oder neurogenen OAB im Hinblick auf eine Muskelschwäche bzw. Sturzgefährdung als sicher erscheinen.

Abstract

Introduction Muscle weakness after botulinum toxin injection into the detrusor muscle due to refractory overactive bladder is reported by approximately 10 % of patients in clinical studies. This could further aggravate the risk of falls in geriatric patients. For the first time, the potential problem of muscle weakness after urologic treatment with botulinum toxin was to be investigated by a geriatric assessment (hand grip measurement).

Material und method In a prospective study design, hand grip was measured before and three months after botulinum toxin injection into the urinary bladder in a dose of 100 – 200 MU. The measurement was performed with the usual hand grip device by pressing the pressure gauge three times with the dominant hand. Relevant muscle weakness was assumed if hand grip was reduced by more than 20 %. The measurement of 100 patients was intended.

Results In an interim analysis of 53 patients with an average age of 65.25 ± 13.99 years, the decrease in hand grip was + 0.00 ± 0.06 kPa or –0.13 ± 1.69 %. In patients receiving 100 MU of botulinum toxin, the decrease was +0.01 ± 0.06 kPa or –0.29 ± 1.64 %; after injection of 200 MU, it was 0.02 ± 0.06 kPa or 0.720 ± 1.77 %. The changes were neither significant for the overall population nor for the differences between the dosage groups. Therefore, the study was terminated.

Conclusion The results of the hand grip measurement performed after botulinum toxin injection into the detrusor muscle demonstrated for the first time that there is no loss in hand grip as a possible indicator of muscle weakness and a risk of falls after urologic treatment with 100 MU or 200 MU. Accordingly, the botulinum toxin injection due to refractory overactive bladder seems to be safe for geriatric patients.

Schlüsselwörter

geriatrischer Patient - Sturzgefährdung - Handkraftmessung - Botulinumtoxin - überaktive Blase

Keywords

geriatric patient - risk of falling - hand grip measurement - botulinum toxin - overactive bladder

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