title: Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding.
abstract: OBJECTIVE
  We investigated the role of botulinum toxin type A and urotherapy in the treatment of children with dysfunctional voiding.
  
  
  METHODS
  Nine female children with dysfunctional voiding refractory to standard urotherapy and alpha1-adrenergic blocking agents were included in the prospective clinical study. Botulinum toxin type A in a dose of 500 units was injected transperineally into the external urinary sphincter. Bladder rehabilitation was introduced 2 weeks after botulinum toxin type A treatment. Uroflow studies with ultrasound residual urine volumes were obtained before and 6 months after treatment. All children were tested before and 6 months after treatment using the empirically designed International Reflux Study in Children modified questionnaire.
  
  
  RESULTS
  After treatment the mean +/- SD voided volume increased from 180 +/- 73 to 228 +/- 94 ml (p <0.05) while post-void residual urine volume decreased from 52 +/- 40 to 19 +/- 18 ml (p <0.05). Significant differences in other uroflowmetry parameters were not found. However, significant symptom score improvement was detected 6 months after treatment, being decreased by 7 vs 20 (p <0.01). No systemic side effects occurred following botulinum toxin type A injection.
  
  
  CONCLUSIONS
  Our study demonstrates that the voiding mechanism in children with dysfunctional voiding refractory to standard therapy can be significantly improved and maintained at least 6 months after combined botulinum toxin type A injection and bladder rehabilitation.
authors.affiliation: Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Nis, Serbia. petvesna@eunet.yu
authors.forename: Vesna
authors.initials: V
authors.lastname: Petronijevic
authors.forename: Milica
authors.initials: M
authors.lastname: Lazovic
authors.forename: Marina
authors.initials: M
authors.lastname: Vlajkovic
authors.forename: Andjelka
authors.initials: A
authors.lastname: Slavkovic
authors.forename: Emilija
authors.initials: E
authors.lastname: Golubovic
authors.forename: Predrag
authors.initials: P
authors.lastname: Miljkovic
mesh_terms: D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000175:diagnosis / Q000628:therapy; D016055:Urinary Retention / Q000188:drug therapy; D014554:Urination / Q000187:drug effects* / Q000502:physiology; D014555:Urination Disorders / Q000175:diagnosis* / Q000628:therapy*; D014563:Urodynamics
chemical_list: D019274:Botulinum Toxins, Type A