TY - JOUR
T1 - Intravesical injections of botulinum toxin type a for management of neuropathic bladder
T2 - A comparison of two methods
AU - Safari, Saeed
AU - Jamali, Sara
AU - Habibollahi, Peiman
AU - Arshadi, Hamid
AU - Nejat, Farideh
AU - Kajbafzadeh, Abdol Mohammad
N1 - Funding Information:
This project has been supported by a research grant from Tehran University of Medical Sciences .
PY - 2010/7
Y1 - 2010/7
N2 - 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. UROLOGY 76: 225-232, 2010.
AB - 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. UROLOGY 76: 225-232, 2010.
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U2 - 10.1016/j.urology.2009.09.087
DO - 10.1016/j.urology.2009.09.087
M3 - Article
C2 - 20110117
AN - SCOPUS:77955899213
SN - 0090-4295
VL - 76
SP - 225
EP - 230
JO - Urology
JF - Urology
IS - 1
ER -