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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References
- Initial urologic management of myelomeningocele.Urol Clin North Am. 2004; 31 (viii): 427-434
- Predictive value of urodynamic evaluation in newborns with myelodysplasia.JAMA. 1984; 252: 650-652
- Prognostic value of urodynamic testing in myelodysplastic patients. 1981.J Urol. 2002; 167 (discussion: 1054): 1049-1053
- Botulinum toxin injections for paediatric incontinence.Curr Opin Urol. 2005; 15: 264-267
- The safety and efficacy of botulinum toxin type B in the treatment of patients with cervical dystonia: summary of three controlled clinical trials.Neurology. 2000; 55: S29-S35
- Human response to botulinum toxin injection: type B compared with type A.Neurology. 1997; 49: 189-194
- Botulinum toxin: dangerous terminology errors.J R Soc Med. 1993; 86: 493-494
- Molecular pharmacology of botulinum toxin and tetanus toxin.Annu Rev Pharmacol Toxicol. 1986; 26: 427-453
- Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients.J Urol. 1988; 139: 919-922
- Effects of botulinum A toxin on the periurethral striated sphincter of the neurogenic bladder.J Urol (Paris). 1990; 96: 375-380
- Six-year follow-up of botulinum toxin A intradetrusorial injections in patients with refractory neurogenic detrusor overactivity: clinical and urodynamic results.Eur Urol. 2009; 55: 705-711
Apostolidis A, Dasgupta P, Denys P, et al. Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions: a European consensus report. Eur Urol, in press.
- Intravesical injection of botulinum toxin type A: management of neuropathic bladder and bowel dysfunction in children with myelomeningocele.Urology. 2006; 68: 1091-1096
- Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs?.J Urol. 2000; 164: 692-697
- The Paris Consensus on Childhood Constipation Terminology (PACCT) group.J Pediatr Gastroenterol Nutr. 2005; 40: 273-275
- International system of radiographic grading of vesicoureteric reflux.Pediatr Radiol. 1985; 15: 105-109
- Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra.Urology. 2005; 65: 37-41
- The role of ureter in the creation of Mitrofanoff channels in children.J Urol. 1997; 157: 635-637
- Botulinum-A toxin injection into the detrusor: a safe alternative in the treatment of children with myelomeningocele with detrusor hyperreflexia.J Urol. 2004; 171 (discussion: 848): 845-848
- Efficacy of botulinum-A toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary results.Urology. 2002; 59 (discussion: 327-328): 325-327
- Urodynamic evidence of effectiveness of botulinum A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents.Urology. 2004; 63: 868-872
- Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients.J Urol. 1996; 155: 1023-1029
- Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity.J Urol. 2005; 174 (discussion: 982-983): 977-982
- Lack of ultrastructural detrusor changes following endoscopic injection of botulinum toxin type A in overactive neurogenic bladder.Eur Urol. 2004; 46: 784-791
- Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: a double-blind study.Arch Phys Med Rehabil. 1990; 71: 24-26
- Botulinum A toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease.Eur Urol. 2002; 42: 56-62
- Muscular weakness as side effect of botulinum toxin injection for neurogenic detrusor overactivity.Spinal Cord. 2002; 40: 599-600
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
