Intradetrusor Injections of Onabotulinum Toxin-A in Children With Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment.
10.4111/kju.2014.55.4.281
- Author:
Tufan TARCAN
1
;
Cem AKBAL
;
Cagri A SEKERCI
;
Tuncay TOP
;
Ferruh SIMSEK
Author Information
1. Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey. bilgi@tufantarcan.com
- Publication Type:Original Article
- Keywords:
Myelodysplastic syndromes;
Neurogenic urinary bladder;
Onabotulinum toxin-A;
Overactive detrusor;
Urinary incontinence
- MeSH:
Anesthesia, General;
Catheterization;
Catheters;
Child*;
Compliance;
Humans;
Meningomyelocele;
Muscarinic Antagonists;
Myelodysplastic Syndromes;
Prospective Studies;
Urinary Bladder;
Urinary Bladder, Neurogenic;
Urinary Bladder, Overactive;
Urinary Incontinence*;
Urodynamics
- From:Korean Journal of Urology
2014;55(4):281-287
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: This was a prospective single-arm study to assess the efficacy and safety of intradetrusor injections of onabotulinum toxin-A in children with urinary incontinence associated with neurogenic detrusor overactivity due to myelomeningocele. All patients had failed the first-line treatment of a combination of oral antimuscarinics and intermittent catheterization. MATERIALS AND METHODS: The study group consisted of 31 children with myelomeningocele with a mean age of 7.95 years (range, 5-3 years) who were followed up for a mean of 29 weeks. The amount of onabotulinum toxin A injected was 10 U/kg with a maximal dose of 300 U. There were 20 to 30 injection sites with rigid cystoscopic guidance under general anesthesia. RESULTS: Thirty of 31 patients reported dryness between intermittent catheterization intervals. The mean reduction in maximum detrusor pressure and the mean increase in maximum cystometric capacity from baseline were 53% and 51.5%, respectively, 6 weeks after injection. We found a 324% increase in mean bladder compliance and a 57% increase in mean intermittent catheterization volumes. The mean duration of efficacy was 28 weeks with a single injection and 36 weeks for repeated injections (minimum, 16 weeks; maximum, 52 weeks). The mean time interval between repeated onabotulinum toxin-A injections was 7 months (maximum, 13 months). Intradetrusor injections of onabotulinum toxin-A were well tolerated. CONCLUSIONS: Onabotulinum toxin-A injections into the bladder wall provide a significant symptomatic and urodynamic improvement in children with neurogenic detrusor overactivity due to myelomeningocele who are on intermittent catheterization. The treatment seems to be safe and very well tolerated.
