[Show abstract][Hide abstract] ABSTRACT: Objectives
The effectiveness of focal injections of botulinum toxin type A (BoNTA) in relieving symptoms of urinary incontinence (UI) and reducing raised detrusor pressure associated with the risk of renal complications was evaluated in both adults and children with neurogenic UI.Methods
In study 1, 59 adults with neurogenic detrusor overactivity (NDO) were randomised to receive either placebo or BoNTA (200 U or 300 U BOTOX®) via 30 intradetrusor injections. In study 2, 24 children with NDO who were at risk of kidney impairment were given injections with BoNTA at 12 U/kg (maximum: 300 U) at approximately 40 sites in the detrusor.ResultsIn study 1, UI episodes decreased by 50% and maximum detrusor pressure (MDP) and maximum bladder capacity (MBC) were significantly improved in both the 200-U and 300-U treatment groups. In study 2, MDP had decreased by 41% at 1 mo and by 22% at 3 mo (and had increased nonsignificantly by 4% at 6 mo). MBC had increased by 35%, 23%, and 36%, respectively, at the same intervals. There was no evidence of drug resistance after repeated injections and BoNTA was well tolerated.Conclusions
BoNTA was effective in reducing UI episodes and improving urodynamic parameters in adults and children with UI due to NDO.
[Show abstract][Hide abstract] ABSTRACT: Since its introduction in the late 1970s for the treatment of strabismus and blepharospasm, botulinum toxin (BoNT) has been
increasingly used in the interventional treatment of several other disorders characterized by excessive or inappropriate muscle
contractions. Over the years, the number of primary clinical publications has grown exponentially, and still continues to
increase. It has been shown that BoNT blocks cholinergic nerve endings in the autonomic nervous system but does not block
non-adrenergic non-cholinergic responses mediated by nitric oxide (NO).
The present paper reviews a number of recent clinical indications for urological and pelvic floor dysfunctions, such as overactive
and neurogenic bladder, non-bacterial prostatitis, benign prostatic hyperplasia, chronic anal fissure, or conditions associated
to hyperactivity of the puborectalis muscle during straining. These indications provide a new promising palette of indications
for future usage of BoNT in clinical practice.
Neurotoxicity Research 05/2006; 9(2):161-172. · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This review highlights a recent innovation in the medical treatment of children with neurogenic detrusor overactivity. Anticholinergics are usually the main way to treat bladder overactivity. Side effects and lack of efficacy are the two main causes for considering alternative treatment. Up to recently, invasive surgery, mainly bladder augmentation, was the only available treatment for these intractable bladders. Here, we report on botulinum A toxin injection as an alternative to surgery in children with neurogenic detrusor overactivity.
There are only four published articles on the use of botulinum A toxin in children with neurogenic detrusor overactivity. However, an increasing number of reports indicate clinical benefit and a good safety profile of botulinum A toxin in neurogenic and idiopathic detrusor overactivity. Extrapolation of the data published in adults treated with botulinum A toxin injections and understanding the mechanism of action on the detrusor muscle are worthwhile to encourage paediatric physicians to propose this option to their patients. Furthermore, the literature does not seem to warn against drug resistance or ultrastructural changes of the detrusor after repeated injection.
Botulinum A toxin appears to be a reasonable alternative to surgery in the management of intractable overactive bladder in children. However, studies of the delivery method, site of injection, dose and long-term follow-up are required to confirm the good safety profile/clinical benefit of this new, minimally invasive approach.
Current Opinion in Urology 08/2005; 15(4):264-7. · 2.20 Impact Factor
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