Objectives
To evaluate and compare the efficacy of botulinum toxin intravesical injections with
and without injections in external urethral sphincter in treating bladder hyper-reflexia
in children suffering from myelomeningocele.
Methods
A total of 60 patients with bladder hyper-reflexia due to myelomeningocele were randomly
allocated to treatment groups A and B and were followed up for 6 months. Under cystoscopic
guidance, 10 IU/kg of botulinum toxin A was injected into the detrusor muscle, sparing
the trigone and ureteral orifices in group A. Group B received 8 IU/kg of toxin via
the same method compared with group A and 2 IU/kg of toxin through 4 injections in
external urethral sphincter. Conventional urodynamics, daily incontinence score, constipation,
and creatinine level were evaluated at baseline, 3 months, and 6 months after intervention.
Vesicoureteral reflux was also assessed before and after 3 months of injections.
Results
All patients showed significant improvement in bladder capacity (P <.01), maximal detrusor pressure (P <.01), and detrusor-sphincter dyssynergia (P <.01) after 3 and 6 months of receiving injections. Significant improvement in postvoiding
residual volume was observed only among patients of group B (P <.05). Both methods resulted in a significant reduction in daily incontinence grade,
constipation, and vesicoureteral reflux (P <.05), but comparison between the study groups showed better outcomes for group B
in relation to incontinency, constipation, vesicoureteral reflux, and creatinine level.
Conclusions
Botulinum toxin type A injections in both sphincter and detrusor seems to have extra
benefits such as decreasing postvoiding residual volume and more symptom diminution
compared with intradetrusal injections alone.
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Article Info
Publication History
Published online: January 28, 2010
Accepted:
September 24,
2009
Received:
July 16,
2009
Footnotes
This project has been supported by a research grant from Tehran University of Medical Sciences .
Abdol-Mohammad Kajbafzadeh, Hamid Arshadi and Farideh Nejat take the responsibility for data integrity and accuracy and both were involved in patient selection, management, and data acquisition. Saeed Safari and Sarah Jamali were involved in study management and conducting blind allocation. They also reviewed the manuscript content for intellectual content. Peiman Habibollahi analyzed and interpreted the data and drafted the manuscript.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial CommentUrologyVol. 76Issue 1
- PreviewThe data in this report demonstrate that injection of botulinum toxin into both the external urethral sphincter and the detrusor may be more beneficial than injection into the detrusor alone. One might have thought that relaxation of the external urethral sphincter would result in more incontinence between catheterizations, but that does not seem to be the case. A significant advantage is that postvoid residuals are lower in children who voluntarily void, which could decrease the incidence of recurrent urinary infections in some children.
- Full-Text
- Preview
- Editorial CommentUrologyVol. 76Issue 1
- PreviewOur experience with off-label use of botulinum toxin continues to grow. As our experience using this treatment for neurogenic and non-neurogenic overactive bladder increases, we find that, while certain questions are being answered, more questions are surfacing. The pediatric urological literature has shown that patients injected with botulinum toxin demonstrate a reduction in incontinence episodes, an increase in bladder capacity, and a reduction in dangerous detrusor pressures—results that appear to last 6-9 months.
- Full-Text
- Preview
