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Long-term follow-up after botulinum toxin A (BTX-A) injection into the detrusor for treatment of neurogenic detrusor hyperactivity in children.

Zeino M, Becker T, Koen M, Berger C, Riccabona M - Cent European J Urol (2012)

Bottom Line: Five of them were successful.Four patients did not respond and were treated by ileocystoplasty.BTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology, KH Barmhezige Schwester Linz, Austria.

ABSTRACT

Purpose: To prove the long-term efficacy of BTX-A injection in the management of children with neurogenic detrusor hyperactivity.

Materials and methods: 28 out of 145 children with neurogenic bladder (15 male and 13 female, mean age 10.7 years) who were treated between 2002 and 2010 and became non-responders to conservative treatment were included into the retrospective study. We injected 10-12 U/kg of BTX-A (Botox(®)) into the detrusor at 20-30 sites, sparing the trigone. The mean follow-up was 48 months (range 6-84 months).

Results: Group 1. 14 patients had a single injection of BTX-A. Five of them were successful. Mean bladder reflex volume increased (from 62.9 to 117.5 ml), maximum detrusor pressure decreased (from 59 to 37.5 cm H2O), detrusor compliance increased (from 4.8 to 9.5 ml/cm H2O), and leak-point-pressure decreased (from 46.5 to 24.2 cm H2O). Four patients did not respond and were treated by ileocystoplasty. Another five were lost to follow-up. Group 2. 14 patients had repeated (mean 2.5) injections of BTX-A with a mean interval of 13.7 months. In thirteen patients, urodynamic parameters of the first and last injection were similar to those obtained in Group 1, showing a good response. One patient received an ileocystoplasty.

Conclusion: BTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC). The efficacy lasted a mean of 12 months and urodynamic response was unchanged even after several injections. In our series, 21.7% of children with severe low-compliance bladders were non-responders.

No MeSH data available.


Related in: MedlinePlus

Urodynamic parameters before and after BTX-A detrusor injection (group 1).
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Figure 0002: Urodynamic parameters before and after BTX-A detrusor injection (group 1).

Mentions: Urodynamic parameters: According to the results obtained three months after BTX-A Injection the mean reflex volume increased from 62.9 ml to117.5 ml (P <0.01). The maximum bladder capacity increased from 120 ml to 153 ml (P <0.01), the maximum detrusor pressure decreased from 59 mbar to 32.5 mbar (P = 0.05). Bladder compliance increased from 4.8 ml/ mbar to 9.5 ml/ mbar (P = 0.05). The leak point pressure decreased from 46.5 mbar to 24.2 mbar (P = 0.01). (Fig. 2. Five patients did not require any reinjection).


Long-term follow-up after botulinum toxin A (BTX-A) injection into the detrusor for treatment of neurogenic detrusor hyperactivity in children.

Zeino M, Becker T, Koen M, Berger C, Riccabona M - Cent European J Urol (2012)

Urodynamic parameters before and after BTX-A detrusor injection (group 1).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921792&req=5

Figure 0002: Urodynamic parameters before and after BTX-A detrusor injection (group 1).
Mentions: Urodynamic parameters: According to the results obtained three months after BTX-A Injection the mean reflex volume increased from 62.9 ml to117.5 ml (P <0.01). The maximum bladder capacity increased from 120 ml to 153 ml (P <0.01), the maximum detrusor pressure decreased from 59 mbar to 32.5 mbar (P = 0.05). Bladder compliance increased from 4.8 ml/ mbar to 9.5 ml/ mbar (P = 0.05). The leak point pressure decreased from 46.5 mbar to 24.2 mbar (P = 0.01). (Fig. 2. Five patients did not require any reinjection).

Bottom Line: Five of them were successful.Four patients did not respond and were treated by ileocystoplasty.BTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Urology, KH Barmhezige Schwester Linz, Austria.

ABSTRACT

Purpose: To prove the long-term efficacy of BTX-A injection in the management of children with neurogenic detrusor hyperactivity.

Materials and methods: 28 out of 145 children with neurogenic bladder (15 male and 13 female, mean age 10.7 years) who were treated between 2002 and 2010 and became non-responders to conservative treatment were included into the retrospective study. We injected 10-12 U/kg of BTX-A (Botox(®)) into the detrusor at 20-30 sites, sparing the trigone. The mean follow-up was 48 months (range 6-84 months).

Results: Group 1. 14 patients had a single injection of BTX-A. Five of them were successful. Mean bladder reflex volume increased (from 62.9 to 117.5 ml), maximum detrusor pressure decreased (from 59 to 37.5 cm H2O), detrusor compliance increased (from 4.8 to 9.5 ml/cm H2O), and leak-point-pressure decreased (from 46.5 to 24.2 cm H2O). Four patients did not respond and were treated by ileocystoplasty. Another five were lost to follow-up. Group 2. 14 patients had repeated (mean 2.5) injections of BTX-A with a mean interval of 13.7 months. In thirteen patients, urodynamic parameters of the first and last injection were similar to those obtained in Group 1, showing a good response. One patient received an ileocystoplasty.

Conclusion: BTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC). The efficacy lasted a mean of 12 months and urodynamic response was unchanged even after several injections. In our series, 21.7% of children with severe low-compliance bladders were non-responders.

No MeSH data available.


Related in: MedlinePlus