評論
膀胱是身體內的器官中，極少數可以把藥灌進去，不用靠打針或吃藥的方式，就可以把病從局部治療好的，首先大家最熟悉的就是膀胱癌內的化學治療。使用相同類似的概念，把抗生素灌入膀胱內，是否可以改善反覆頑固性的泌尿道感染呢？

來自英國的Bristol團隊做了這個研究，第一作者還是大名鼎鼎的Paul Abrams教授，他們在兩年期間，總共治療27位反覆泌尿道感染的病人，請他們每天在家裡睡覺前，將一支80mg的gentamicin泡成50ml灌入膀胱內，如果可以的話，就請病人可能盡量把抗生素留在膀胱過夜。同時七天後，會抽血看血液中gentamicin的濃度，如果大於1mg/L就停止灌藥。

結果顯示，在平均26個月治療後，22個病人(84.6%)有明顯減少泌尿道感染，而且病人並沒有副作用或血液藥物濃度過高的情況發生。

所以，雖然這是一個很小，而且沒有控制組的研究，但對於在臨床上實在想不出好辦法去治療反覆泌尿道感染的病人，提供一個另類的選擇。

最後，筆者提出一些私人的經驗分享，我們在過去逼尿肌內注射BOTOX®已經有許多很好的經驗報告，是不是可以將Aminoglycoside這類的藥物，打在逼尿肌或是黏膜下(submucosa)，來治療反覆的泌尿道感染了？歡迎各位同好一起來做個全國的大型研究吧!

AIMS
To assess the use of intravesical gentamicin to treat intractable recurrent urinary tract infections in lower urinary tract dysfunction.

METHODS
A two-center retrospective cohort study of 27 patients treated with intravesical gentamicin was performed over a 2-year period. A treatment protocol was developed, reviewed, and accepted by the clinical effectiveness committee of both hospitals. Patients were taught to instill the gentamicin into the bladder on a nightly basis. Inclusion criteria included failure to respond to standard therapy, having six or more cultured confirmed UTIs over a 12-month period, or at least one hospital admission with sepsis. Serum gentamicin levels were taken after 7 days and the treatment was discontinued if the level was >1 mg/L. Patients were counseled about the limited evidence base for this treatment.

RESULTS
Twenty-seven patients have been treated with intravesical gentamicin for an average of 26 months. Seventeen were performing ISC, five had suprapubic catheters, three were voiding, and two had ileal conduits at the time of instituting treatment. All patients started on daily 80 mg gentamicin. Twenty two patients had less frequently occurring infections after starting intravesical gentamicin treatment. Six stopped the treatment and none had side effects as a result of the instillations.

CONCLUSIONS
This study has shown that in a small group of adult patients who have multiple symptomatic UTIs refractory to conventional treatment, intravesical gentamicin is effective in reducing the frequency of infections. The treatment is well tolerated with no evidence of systemic absorption