title: Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients.
abstract: OBJECTIVE
  We evaluated the effect of botulinum toxin type A (BTX-A) injections in the trigone on the antireflux mechanism and evaluated its short-term efficacy.
  
  
  METHODS
  Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX-A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics.
  
  
  RESULTS
  At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX-A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271+/-92 to 390+/-189 ml (p=0.002), reflex volume varied from 241+/-96 to 323+/-201 ml (p=0.020) and maximum detrusor pressure reduced from 66+/-39 to 38+/-37 cm H(2)O (p<0.001).
  
  
  CONCLUSIONS
  Our results confirm the safety of trigone injections of BTX-A in terms of development of VUR and upper urinary tract damage. Whether they are beneficial for patients with NDO or other causes of voiding dysfunction will need further studies.
authors.affiliation: Department of Urology, Hospital Santo Antonio das Obras Sociais Irmã Dulce, Bahia, Brazil. fredericomascarenhas@ig.com.br
authors.forename: Frederico
authors.initials: F
authors.lastname: Mascarenhas
authors.forename: Marcello
authors.initials: M
authors.lastname: Cocuzza
authors.forename: Cristiano Mendes
authors.initials: CM
authors.lastname: Gomes
authors.forename: Nilo
authors.initials: N
authors.lastname: Leão
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D014549:Urinary Incontinence / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014563:Urodynamics; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000139:chemically induced
chemical_list: D018727:Muscarinic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A