Botulinum-A Toxin in the Treatment of Neurogenic Bladder in Children

ArticleinPEDIATRICS 110(2 Pt 1):420-1 · September 2002
Impact Factor: 5.47 · DOI: 10.1542/peds.110.2.420-a · Source: PubMed
    • "...2% of children for whom anticholinergic medication has failed require bladder augmentation surgery [28] . Whereas the first clinical priority in children is maintenance of renal function, augmentation su..."
      However, a significant proportion of patients are inadequately managed by oral anticholinergics, and the common side-effects of dry mouth and constipation often prove intolerable, particularly because high doses are often required to control symptoms2021222324252627. Approximately 8–12% of children for whom anticholinergic medication has failed require bladder augmentation surgery [28] . Whereas the first clinical priority in children is maintenance of renal function, augmentation surgery is a permanent step with its own risks so is best prevented or postponed in the long-term management of NDO in children [29].
    [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.
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  • [Show abstract] [Hide abstract] ABSTRACT: This review highlights a recent innovation in the medical treatment of detrusor overactivity (DO). Anticholinergics are usually the gold standard to treat bladder overactivity. Side-effects and lack of efficacy are the two main causes for considering alternative treatments. Up to recently, only invasive surgery, mainly bladder augmentations were the only available treatment option for these intractable bladders. This chapter considers botulinum-A toxin (BTX-A) injection as an alternative treatment to surgery in patients with DO who failed anticholinergic therapy.
    No preview · Article · Jan 2005 · Urodinamica
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