Repeated Intradetrusor Application of Botulinum Toxin A in Children with Detrusor Overactivity

Česká verzia

Authors: P. Zerhau ¹; M. Husár ¹; E. Brichtová ²; Z. Mackerle ²; O. Šmakal ³; J. Vrána ³
Authors place of work: Odd. dětské urologie, Klinika dětské chirurgie, ortopedie a traumatologie LF MU a FN Brno ¹; Odd. dětské neurochirurgie, Klinika dětské chirurgie, ortopedie a traumatologie LF MU a FN Brno ²; Urologická klinika LF UP a FN Olomouc ³
Published in the journal: Cesk Slov Neurol N 2011; 74/107(4): 471-474
Category: Short Communication

Summary

Objective:
Analysis of therapy by repeated intradetrusor application of botulinum toxin A in children’s urinary bladder detrusor overactivity. Material and methods: The study included a total of 17 patients between the ages of 6 and 14 years (mean 9.5, median 9). Eight of them were treated for neurogenic detrusor overactivity (Group I: 4 girls and 4 boys), and nine for non-neurogenic detrusor overactivity (Group II: 3 girls and 6 boys). Botulinum toxin A at a dose of 10 to 12 IU/ kg, in proportion to body weight, was applied endoscopically. Nine patients were treated twice, the others two or three times 6 months after previous injection in every case. Both urodynamic data and bladder diary data were assessed 1, 3, and 6 months after each application. Results: 11 patients (65%) showed improved urine continence while 2 (11%) of patients exhibited full extinction of incontinence. Extinction and/or reduction of non-inhibited detrusor contractions always culminated in the third month after application. No one child demonstrated a change of miction regime or need for catheterisation. Maximum increase of cystometric capacity took effect after 3 months: in Group I by 55% (107 ±76 ml; p = 0.0068), in Group II by 40% (72 ±41 ml; p = 0.0010). The degree of greatest decrease of maximum detrusor pressure was: Group I by 49% (29 ±11.2 cm H₂O; p = 0.0126) three months after application; Group II by 64% (45 ±16.5 cm H₂O; p = 0.0069), one month after second application. No adverse effects emerged during treatment. Conclusion: Intradetrusor application of botulinum toxin A appears to be a safe and efficient treatment for detrusor overactivity in children, regardless of its origin. Repeated application does not potentiate the effect of this treatment.

Key words:
neurogenic bladder – botulinum toxin A – detrusor overactivity – incontinence

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