title: Repeated Botulinum-A toxin injection in the treatment of neuropathic bladder dysfunction and poor bladder compliance in children with myelomeningocele.
abstract: OBJECTIVE
  To evaluate the efficacy of intradetrusor injection of Botulinum-A toxin (BoNT/A) in children with neuropathic bladder dysfunction and poor bladder compliance, due to meningomyelocele.
  
  
  METHODS
  We retrospectively reviewed the charts of 11 children (mean age 6.7 ± 5.3 years) with neuropathic bladder and poor bladder compliance (mean 7 ml/cmH(2) O) treated with intradetrusor injection of BoNT/A. After urodynamic evaluation a standardized injection was performed. The authors describe their results in 11 children after the first (5×) or repeated (6×) BoNT/A injections. Re-evaluation was performed 3 and 12 months after each injection.
  
  
  RESULTS
  Three months after injection detrusor pressure decreased by 17% and bladder capacity increased by 33%. In all but 1 patient bladder compliance stayed poor. Twelve months after treatment patients still had an effect but the values were already reverting towards preoperative levels. With repeated injections we achieved a similar effect on capacity and detrusor pressure as after the first injection. Overall, bladder compliance normalized (>20 cmH(2) O) in only 1 patient.
  
  
  CONCLUSIONS
  The results confirmed the positive temporary effect of BoNT/A on detrusor pressure and bladder capacity in children with myelomeningocele, even after repeated injections. Nevertheless, bladder compliance stayed severely pathological. Whether an earlier treatment may prevent poor bladder compliance is a yet unanswered question.
authors.affiliation: Division of Paediatric Urology, University Children's Hospital Zurich, Zurich, Switzerland. maya.horst@usz.ch
authors.forename: Maya
authors.initials: M
authors.lastname: Horst
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Weber
authors.forename: Christine
authors.initials: C
authors.lastname: Bodmer
authors.forename: Rita
authors.initials: R
authors.lastname: Gobet
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D000367:Age Factors; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003187:Compliance; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000150:complications* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D011312:Pressure; D012189:Retrospective Studies; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000294:innervation / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA