[Indications and results of intradetrusor of botulinum toxin type A injections in children].
OBJECTIVE
The authors report their experience of intradetrusor injections of botulinum toxin type A (TBA) in children. This treatment was deliberately limited to patients with acquired neurogenic bladder, high detrusor pressures and urinary incontinence despite anticholinergic therapy.


METHODS
Six children with a mean age of 11.6 years (range: five to 18 years) treated by intermittent catheterization presented an indication for intradetrusor injection of TBA. One half of these patients presented recurrent urinary tract infections. Their leak point pressure was greater than or equal to 40 cmH(2)O (mean: 67+/-33.6) and the bladder capacity of these children was less than the capacity predicted for age (mean: 68%+/-32.8). TBA was injected into 20 to 30 sites by cystoscopy at a dose of 12 IU/kg of body weight (maximum dose: 300 IU).


RESULTS
No adverse effects were observed. Only one child still presented incontinence, but only during urinary tract infections. Four children were able to stop their anticholinergic treatment. Two months after the injection, all children had normal detrusor pressures (mean: 24.2+/-7.4 cmH(2)O). The maximum cystomanometric capacity then exceeded the predicted capacity (113%+/-22).


CONCLUSIONS
In acquired neurogenic bladder with detrusor hyperactivity, TBA protects the upper urinary tract (by decreasing detrusor pressures) and controls urinary incontinence (by increasing the functional bladder capacity), without preventing subsequent bladder augmentation.
Dobremez
E
E
Service de chirurgie pédiatrique, hôpital Pellegrin-Enfants, CHU de Bordeaux, université Victor-Segalen, Bordeaux-2, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. eric.dobremez@chu-bordeaux.fr
Llanas
B
B
Shao
E
E
de Seze
M
M
D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008365:Manometry; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy; D014563:Urodynamics
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A