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Botulinum Toxin Type A Therapy: Intravesical Injection or Electromotive Drug Administration

  • Seyedeh-Sanam Ladi-Seyedian
    Affiliations
    Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center Excellence, Tehran University of Medical Sciences, Tehran, Iran
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  • Lida Sharifi-Rad
    Affiliations
    Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center Excellence, Tehran University of Medical Sciences, Tehran, Iran

    Department of Physical Therapy, Children's Medical Center, Pediatric Center Excellence, Tehran University of Medical Sciences, Tehran, Iran
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  • Abdol-Mohammad Kajbafzadeh
    Correspondence
    Address correspondence to: Abdol-Mohammad Kajbafzadeh, M.D., Pediatric Urology and Regenerative Medicine Research Center, Pediatric Center of Excellence, Children's Medical Center, No. 62, Dr. Qarib's St, Keshavarz Blvd, Tehran 14194 33151, Iran.
    Affiliations
    Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center Excellence, Tehran University of Medical Sciences, Tehran, Iran
    Search for articles by this author

      Objectives

      To compare the outcomes of intravesical injection of botulinum toxin A (BoNTA) with intravesical electromotive drug administration (EMDA) of BoNTA on urinary incontinence secondary to neuropathic detrusor overactivity (NDO) in children with myelomeningocele (MMC).

      Materials and methods

      A total of 26 children with MMC (11 boys, 15 girls) who had urinary incontinence secondary to NDO were retrospectively enrolled in the study. Patients in EMDA group (n = 14), using an electrode-catheter, 10 IU/kg of BoNTA were inserted into the bladder for EMDA without anesthesia and on an outpatient basis. The EMDA equipment was connected to the electrode of indwelling catheter and 2 dispersive electrodes, a pulsed current generator delivered 10-20 mA for 20 minutes. Patients in injection group (n = 12) were received interavesical injection of 10 IU/kg of BoNTA via rigid cystoscope on an inpatient basis. All patients had been evaluated by a voiding diary, urodynamic study, renal, and bladder ultrasounds before, 6 months and 1 year after the treatment.

      Results

      Six months after the treatment, 12 of 14 (85.7 %) and 8 of 12 (66.6%) patients in EMDA and injection groups respectively became completely dry between 2 consecutive clean intermittent catheterizations, which maintained in 11 of 14 (78.5%) of patients in EMDA group compared to 6 of 12 (50%) of patients in injection group, 1 year after the treatment.

      Conclusion

      Patients in both groups improved after the treatment; however improvement in EMDA group was more prominent with better sustained effects. BoNTA/EMDA is a feasible, reproducible, cost benefit, and pain free method as an outpatient basis and no need for anesthesia.
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