Intravesical Injections of Botulinum Toxin Type A for Management of Neuropathic Bladder: A Comparison of Two Methods

Published:January 28, 2010DOI:


      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.


      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.


      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.


      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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      Linked Article

      • Editorial Comment
        UrologyVol. 76Issue 1
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          The 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.
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      • Editorial Comment
        UrologyVol. 76Issue 1
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          Our 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.
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