title: [Botulinum toxin in the failure of high urinary diversion closure].
abstract: BACKGROUND
  The closure of urinary diversions performed on newly born infants has a notable failure percentage in patients with bladder disease. We present the use of botulinum toxin as a useful and minimally invasive alternative to treat these patients.
  
  
  METHODS
  We present two patients with a single kidney and with posterior urethral valves (PUV), in whom it was necessary to perform a ureterostomy due to chronic kidney disease. In both patients, the subsequent attempt to close the diversion failed. Aged 4 and 10 years respectively, they presented bladders commonly known as "dry bladders", with a low capacity (20 and 110 ml), bad adaptation (1.5 and 3.1 ml/ cm H(2)O) and high opening detrusor pressure. A 10 UI/Kg botulinum toxin A puncture was applied in the detrusor on one and two occasions respectively, prior to the closure of the diversion.
  
  
  RESULTS
  Neither of the patients suffered clinical or ecographic worsening after the closure of the diversion and their kidney function continued without change with respect to the first diversion after one and four years of follow-up respectively. One year after the surgical procedure, video urodynamics showed a significant improvement in bladder capacity (451 and 250 ml), in adaptation (20.4 and 81.9 ml/ cmH(2)O) and in the opening detrusor pressure.
  
  
  CONCLUSIONS
  The closure of high urinary diversions has a high failure percentage in infants with pathological high-pressure bladders. Botulinum toxin may be useful as bladder treatment prior to closure of the diversion, especially in patients with a single kidney.
authors.affiliation: Sección de Urología Pediátrica, Servicio de Cirugía Pediátrica, Hospital Infantil Gregorio Marañón, Madrid, España. parente80@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Parente
authors.forename: J M
authors.initials: JM
authors.lastname: Angulo
authors.forename: R M
authors.initials: RM
authors.lastname: Romero
authors.forename: S
authors.initials: S
authors.lastname: Rivas
authors.forename: C
authors.initials: C
authors.lastname: Corona
authors.forename: A R
authors.initials: AR
authors.lastname: Tardáguila
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008297:Male; D014519:Ureterostomy; D014547:Urinary Diversion
chemical_list: D019274:Botulinum Toxins, Type A