title: A simplified technique for botulinum toxin injections in children with neurogenic bladder.
abstract: OBJECTIVE
  Botulinum toxin type A has revolutionized the treatment of neurogenic bladder dysfunction. The original injection technique used a rigid cystoscope and a flexible collagen needle. To date botulinum toxin type A injection techniques have not been standardized. We present our experience in pediatric patients using a new flexible injection system.
  
  
  METHODS
  We treated 24 patients 3.8 to 17.5 years old who had neurogenic bladder dysfunction with botulinum toxin type A bladder and/or sphincter injection using a rigid cystoscope and the new N-DO™ endo-injector needle system. Another 24 patients 3.6 to 17.8 years old were treated with a 3.7Fr standard flexible needle and served as controls. Operative time, hospital stay, complications and efficacy were considered. Selection criteria and treatment were the same in the 2 groups. The 10 IU/kg dose was determined according to European Association of Urology guidelines.
  
  
  RESULTS
  All patients received botulinum toxin type A bladder injection while 11 patients in the endo-injector group and 5 controls also received urethral injection. In the endo-injector needle and control groups average operative time was 12.4 and 17.3 minutes for the bladder, and 5.1 and 10.1 minutes for the urethra, respectively (each p <0.05). All patients were discharged home the day after the procedure. No complications were observed. Urodynamics revealed an average maximum detrusor pressure decrease of 25 and 21 cm H(2)O, and an average bladder capacity increase of 75 and 80 ml in the endo-injector and control groups, respectively (p not significant).
  
  
  CONCLUSIONS
  While retaining efficacy, the endo-injector needle technique appears to be more rapid than the standard procedure for botulinum toxin type A injection for neurogenic bladder dysfunction. Whether patients may be treated with sedation only remains to be clarified.
authors.affiliation: Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Piazza S. Onofrio 4, Rome, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Pascali
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mosiello
authors.forename: Armando
authors.initials: A
authors.lastname: Marciano
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Capitanucci
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Zaccara
authors.forename: Mario
authors.initials: M
authors.lastname: De Gennaro
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006801:Humans; D007267:Injections / Q000295:instrumentation / Q000379:methods; D009339:Needles; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A