Intravesical Electromotive Botulinum Toxin Type A Administration—Part II: Clinical Application

Kajbafzadeh, Abdol-Mohammad; Ahmadi, Hamed; Montaser-Kouhsari, Laleh; Sharifi-Rad, Lida; Nejat, Farideh; Bazargan-Hejazi, Shahrzad

doi:10.1016/j.urology.2010.06.003

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Volume 77, Issue 2 , Pages 439-445, February 2011

Intravesical Electromotive Botulinum Toxin Type A Administration—Part II: Clinical Application

Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Reprint requests: Abdol-mohammad Kajbafzadeh, M.D., Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital and Medical Center, Tehran University of Medical Sciences, 32, 2nd Floor, Seventh Street, Saadat-Abad Avenue, Tehran 1998714616 Iran
Hamed Ahmadi
- Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Laleh Montaser-Kouhsari
- Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Lida Sharifi-Rad
- Department of Physical Therapy, Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Farideh Nejat
- Department of Neurosurgery, Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Shahrzad Bazargan-Hejazi
- Department of Psychiatry and Human Behavior, Charles R. Drew University of Medicine and Sciences, Los Angeles, California
- Department of Pediatrics, Charles R. Drew University of Medicine and Sciences, Los Angeles, California

Received 22 February 2010; received in revised form 4 June 2010 published online 27 August 2010.

Objectives

To assess the effect of electromotive botulinum toxin type A administration on urodynamic variables, urinary/fecal incontinence, and vesicoureteral reflux (VUR) due to refractory neurogenic detrusor overactivity in children with myelomeningocele.

Methods

A total of 15 children (mean age 7.8 years) were included. Using a specially designed catheter, 10 IU/kg of electromotive botulinum toxin type A was inserted into the distended bladder. While connected to the indwelling catheter and 2 dispersive pads, a pulsed current generator delivered 10 mA for 15 minutes. The urodynamic parameters, including reflex volume, maximal bladder capacity, maximal detrusor pressure, and end-fill pressure, and the urinary/fecal incontinence status and VUR grade were evaluated before and at 1, 4, and 9 months after treatment.

Results

The mean reflex volume and maximal bladder capacity had increased considerably (99 ± 35 mL versus 216 ± 35 mL and 121 ± 39 mL versus 262 ± 41 mL, respectively; P < .001). In contrast, the mean maximal detrusor pressure and end-fill pressure had significantly decreased (75 ± 16 cm H₂O versus 39 ± 10 cm H₂O and 22 ± 7 cm H₂O versus 13 ± 2 cm H₂O) after treatment. The difference was statistically significant (P < .001). Urinary incontinence improved in 12 patients (80%). The VUR grade substantially decreased in 7 of the 12 children (mean VUR grade 2.25 ± 1.3 versus 1.37 ± 0.7; P = .001), and none of the children required surgical intervention. Fecal incontinence was alleviated in 10 (83.3%) of the 12 children. Skin erythema and burning sensation were observed in 6 children.

Conclusions

The results of our study have shown that electromotive botulinum toxin type A administration is a feasible and safe method with no need for anesthesia. This novel delivery system resulted in considerable improvement in the urodynamic parameters, urinary/fecal incontinence, and VUR in patients with refractory neurogenic detrusor overactivity.