title: Vesicoureteral refulx in overactive bladder: medical resolution through botulin toxin injection.
abstract: OBJECTIVE
  Overactive bladder may have a neurogenic or non neurogenic origin. Sometimes, as a result of detrusor overactivity, disorders of the  upper urinary tract function may appear. One of these alterations may be the appearance of associated vesicoureteral reflux. The treatment  of overactive bladder may be done with anticholinergic drugs and if there is not response the use of botulin toxin type A is approved. The aim of this case report is to demonstrate the effect of botulin toxin type A in the treatment of overactive bladder and vesicoureteral  reflux secondary to the overactive bladder.
  
  
  METHODS
  We present the case of a 10-year-old patient without significant past medical history. When he was one year old he had a urinary  infection and voiding cystourethrogram showed grade 1 right vesicoureteral reflux. When he was 4 year old he presented several episodes  of pyelonephritis and then he was diagnosed of severe bilateral vesicoureteral reflux, which did not respond to treatment with Macroplastic ®  or Deflux ®. Urodynamic study was performed showing overactive bladder with decreased bladder compliance.
  
  
  RESULTS
  We performed intravesical injection of 200 U of botulin toxin type A and vesicoureteral reflux disappeared and urodynamic study  improved. One year later we re-injected botulin toxin type A (300 U) and we repeated the injection after one year (300 U). The patient is  currently well, without changes in the urodynamic study and without vesicoureteral reflux.
  
  
  CONCLUSIONS
  Repeated injections of botulin toxin type A has shown great efficacy in the treatment of overactive bladder in children with  vesicoureteral reflux improved secondary.
authors.affiliation: Urology Department, San Cecilio University Hospital, Granada, Spain. arrabalp@ono.com
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Arrabal-Polo
authors.forename: Mercedes
authors.initials: M
authors.lastname: Nogueras-Ocaña
authors.forename: Antonio
authors.initials: A
authors.lastname: Jiménez-Pacheco
authors.forename: Francisco
authors.initials: F
authors.lastname: Palao-Yago
authors.forename: Javier
authors.initials: J
authors.lastname: Tinaut-Ranera
authors.forename: Victor
authors.initials: V
authors.lastname: López-León
authors.forename: Armando
authors.initials: A
authors.lastname: Zuluaga-Gómez
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000150:complications* / Q000188:drug therapy*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A