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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© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Intravesical Injections of Botulinum Toxin Type A for Management of Neuropathic Bladder: A Comparison of Two MethodsUrologyVol. 76Issue 1
- ReplyUrologyVol. 76Issue 1
- PreviewWe 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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