Abstract | OBJECTIVES: METHODS: A total of 60 patients with bladder hyper-reflexia due to myelomeningocele were randomly allocated to treatment groups A and B and were followed up for 6 months. Under cystoscopic guidance, 10 IU/kg of botulinum toxin A was injected into the detrusor muscle, sparing the trigone and ureteral orifices in group A. Group B received 8 IU/kg of toxin via the same method compared with group A and 2 IU/kg of toxin through 4 injections in external urethral sphincter. Conventional urodynamics, daily incontinence score, constipation, and creatinine level were evaluated at baseline, 3 months, and 6 months after intervention. Vesicoureteral reflux was also assessed before and after 3 months of injections. RESULTS: All patients showed significant improvement in bladder capacity (P <.01), maximal detrusor pressure (P <.01), and detrusor-sphincter dyssynergia (P <.01) after 3 and 6 months of receiving injections. Significant improvement in postvoiding residual volume was observed only among patients of group B (P <.05). Both methods resulted in a significant reduction in daily incontinence grade, constipation, and vesicoureteral reflux (P <.05), but comparison between the study groups showed better outcomes for group B in relation to incontinency, constipation, vesicoureteral reflux, and creatinine level. CONCLUSIONS:
Botulinum toxin type A injections in both sphincter and detrusor seems to have extra benefits such as decreasing postvoiding residual volume and more symptom diminution compared with intradetrusal injections alone.
|
Authors | Saeed Safari, Sara Jamali, Peiman Habibollahi, Hamid Arshadi, Farideh Nejat, Abdol-Mohammad Kajbafzadeh |
Journal | Urology
(Urology)
Vol. 76
Issue 1
Pg. 225-30
(Jul 2010)
ISSN: 1527-9995 [Electronic] United States |
PMID | 20110117
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright 2010 Elsevier Inc. All rights reserved. |
Chemical References |
- Neuromuscular Agents
- Botulinum Toxins, Type A
|
Topics |
- Administration, Intravesical
- Botulinum Toxins, Type A
(administration & dosage)
- Child
- Double-Blind Method
- Female
- Humans
- Male
- Meningomyelocele
(complications)
- Neuromuscular Agents
(administration & dosage)
- Prospective Studies
- Urinary Bladder, Neurogenic
(drug therapy, etiology)
|