Repeated Botulinum-A toxin injection in the treatment of neuropathic bladder dysfunction and poor bladder compliance in children with myelomeningocele.

Abstract

AIMS:

To evaluate the efficacy of intradetrusor injection of Botulinum-A toxin (BoNT/A) in children with neuropathic bladder dysfunction and poor bladder compliance, due to meningomyelocele.

METHODS:

We retrospectively reviewed the charts of 11 children (mean age 6.7 ± 5.3 years) with neuropathic bladder and poor bladder compliance (mean 7 ml/cmH(2) O) treated with intradetrusor injection of BoNT/A. After urodynamic evaluation a standardized injection was performed. The authors describe their results in 11 children after the first (5×) or repeated (6×) BoNT/A injections. Re-evaluation was performed 3 and 12 months after each injection.

RESULTS:

Three months after injection detrusor pressure decreased by 17% and bladder capacity increased by 33%. In all but 1 patient bladder compliance stayed poor. Twelve months after treatment patients still had an effect but the values were already reverting towards preoperative levels. With repeated injections we achieved a similar effect on capacity and detrusor pressure as after the first injection. Overall, bladder compliance normalized (>20 cmH(2) O) in only 1 patient.

CONCLUSIONS:

The results confirmed the positive temporary effect of BoNT/A on detrusor pressure and bladder capacity in children with myelomeningocele, even after repeated injections. Nevertheless, bladder compliance stayed severely pathological. Whether an earlier treatment may prevent poor bladder compliance is a yet unanswered question.

• Authors: Maya Horst, Daniel M Weber, Christine Bodmer, Rita Gobet
• Journal: Neurourology and urodynamics (Neurourol Urodyn) Vol. 30 Issue 8 Pg. 1546-9 (Nov 2011) ISSN: 1520-6777 [Electronic] United States
• PMID: 21674597 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Wiley Periodicals, Inc.

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A
• incobotulinumtoxinA

Topics

• Administration, Intravesical
• Adolescent
• Age Factors
• Botulinum Toxins, Type A (administration & dosage, adverse effects)
• Child
• Child, Preschool
• Compliance
• Drug Administration Schedule
• Female
• Humans
• Infant
• Male
• Meningomyelocele (complications, physiopathology)
• Neuromuscular Agents (administration & dosage, adverse effects)
• Pressure
• Retrospective Studies
• Switzerland
• Time Factors
• Treatment Outcome
• Urinary Bladder (drug effects, innervation, physiopathology)
• Urinary Bladder, Neurogenic (drug therapy, etiology, physiopathology)
• Urodynamics (drug effects)