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Editorial Comment

      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. There were also slightly better improvements in the level of continence and grade of vesicoureteral reflux. However, the effect of these injections is temporary, which limits the practicality of this approach. Therefore, children who fail maximal anticholinergic therapy—either by the oral, intravesical or transdermal routes, or combinations thereof—may still require surgical bladder augmentation to reduce bladder pressures and achieve social continence on a permanent basis.
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      Linked Article

      • Intravesical Injections of Botulinum Toxin Type A for Management of Neuropathic Bladder: A Comparison of Two Methods
        UrologyVol. 76Issue 1
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          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.
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        UrologyVol. 76Issue 1
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          We do agree that the effect of botulinum toxin type A (BT-A) is not permanent. We assumed that some issues concerning the botulinum toxin injection and surgical bladder augmentation should be mentioned according to the previous reports and our experience. Several factors are responsible for appropriate voiding and continence such as bladder neck function, pelvic floor muscle tonicity, and external urethral sphincter. Injections of BT-A into the external urethral sphincter theoretically do not disturb the other 2 mechanisms.
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