title: Evolution of the management of acquired neurogenic bladder in children using intradetrusor botulinum toxin type A injections: 5-year experience and perspectives.
abstract: OBJECTIVE
  To report the clinical and urodynamic results of repeated intradetrusor botulinum toxin type A injections in children with an acquired neurogenic bladder.
  
  
  METHODS
  We reviewed the data of 8 patients presenting an acquired neurogenic bladder treated between 2005 and 2010. Their mean age was 12.4 years old (range: 5-18). They were all on clean intermittent catheterization. All patients presented detrusor overactivity resistant to oral anticholinergic treatment. They received between 2 and 6 injections at a dose of 12 botulinum toxin units (BU)/kg (maximum 300 BU). Cystometry was performed 4-8 weeks after treatment.
  
  
  RESULTS
  Five patients became completely dry, 2 were only rarely wet, and data are lacking for 1 patient. Febrile urinary tract infections ceased after 1 or 2 injections. The mean maximal detrusor pressure decreased below 40 cmH(2)O after 1, 2 and 3 injections. The normalized safe capacity rose significantly after 1, 2 and 3 injections. The normalized maximal bladder capacity rose similarly after 1, 2 and 3 injections although not always significantly.
  
  
  CONCLUSIONS
  Intradetrusor botulinum toxin-A injections significantly reduce detrusor pressure and can be repeated with efficacy. They have their place in between anticholinergic treatment and surgery. The procedure could be simplified and the dosage reduced.
authors: Service de Chirurgie Pédiatrique, Hôpital des Enfants, CHU de Bordeaux, Place Amélie Raba Léon, 33 076 Bordeaux, France. ln.rachel@gmail.com
authors: R
authors: R
authors: Le Nué
authors: L
authors: L
authors: Harper
authors: M
authors: M
authors: De Sèze
authors: C
authors: C
authors: Bouteiller
authors: D
authors: D
authors: Goossens
authors: E
authors: E
authors: Dobremez
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A