Abstract | PURPOSE: MATERIALS AND METHODS: A total of 15 children (10 male and 5 female, mean age 5.8 years), all on clean intermittent catheterisation (CIC) due to MMC, were "non responders" to orally and intravesically administered anticholinergic medication. Pretreatment assessment included a videourodynamic evaluation, incontinence scoring and a mercaptoacetyltriglycine-3 renal scan. We injected from 10 U/kg up to a maximum of 360 U botulinum-A toxin at 25-40 sites of the detrusor, sparing the trigone. Follow-up was 24 months. All children had a urodynamic reevaluation with assessment of bladder capacity and incontinence score at 3, 9 and 12 months. RESULTS: Mean bladder reflex volume increased from 72.00 +/- 28.12 ml to 298 +/- 32.45 ml (p < 0.001). The maximal detrusor pressure decreased from 78.76 +/- 23.14 cm H(2)O to 42.76 +/- 24.34 cm H(2)O (p < 0.001). Maximal bladder capacity increased from 136.34 +/- 45.71 ml to 297.02 +/- 87.17 ml (p < 0.001). Detrusor compliance increased from 18.29 +/- 27.19 ml/cm H(2)O to 51.17 +/- 38.17 ml/mmH(2)O (p < 0.001). While 10 patients became completely dry between CIC, the remaining 2 patients improved from score 3 to 1. Results at 9 months were similar to the ones at 3 months. The mean efficacy and durability of the toxin was 10.5 months after the first intravesical injection. CONCLUSIONS:
Botulinum-A toxin is a safe alternative in the management of detrusor hyperreflexia in MMC children. Preliminary results are promising concerning urodynamic parameters and continence.
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Authors | L Lusuardi, A Nader, M Koen, A Schrey, M Schindler, M Riccabona |
Journal | Aktuelle Urologie
(Aktuelle Urol)
Vol. 35
Issue 1
Pg. 49-53
(Feb 2004)
ISSN: 0001-7868 [Print] Germany |
Vernacular Title | Minimalinvasive, sichere Behandlung der neurogenen Blase bei Myelomeningozelen-Kindern mit Botulinum-Toxin A. |
PMID | 14997415
(Publication Type: Clinical Trial, English Abstract, Journal Article)
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Chemical References |
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Topics |
- Botulinum Toxins, Type A
(administration & dosage)
- Child
- Child, Preschool
- Female
- Follow-Up Studies
- Humans
- Injections, Intramuscular
- Male
- Meningomyelocele
(complications)
- Muscle Hypertonia
(drug therapy)
- Prospective Studies
- Treatment Outcome
- Urinary Bladder, Neurogenic
(drug therapy)
- Urodynamics
(drug effects)
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