title: [Botulinic toxin type A in the treatment of children with neurogenic bladder].
abstract: INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder refractory to anticholinergics. OBJECTIVE. To evaluate the initial effects of BoNTA in neurogenic bladders. PATIENTS AND METHODS 12 patients (9 myelomeningoceles, 1 tethered cord, 1 medullary astrocytoma, 1 Ewing's sarcoma) were studied. The pretreatment evaluation included: voiding diary, incontinence score, renovesical ultrasound, cystourethrography and urodynamic parameters. Patients received 300 UI of BoNTA via detrusor injections. They were re-evaluated at months 1, 3 and 6. After the third control, if improvement was confirmed, patients were injected again. Otherwise, surgery was indicated.
  
  
  RESULTS
  After the initial injection, 50% of patients achieved complete continence and 20% remained with minimal leaks. The mean maximum bladder capacity increased from 264 +/- 117 ml to 324 +/- 170 ml (P = 0.322). The mean detrusor pressure decreased from 46 +/- 17 cm H2O to 42 +/- 14 cm H2O (P=0.596). The mean bladder compliance increased from 7.6 +/- 5.9 ml/cm H2O to 10.4 +/- 6.4 ml/cm H2O (P = 0.290). The reflex voiding contractions disappeared in 2 patients; 8 presented trabeculae. Ten patients were reinjected and two underwent surgery.
  
  
  CONCLUSIONS
  70% urinary continence was achieved after the initial injection. No significant urodynamic changes were observed. A longer follow-up with subsequent injections is needed.
authors.affiliation: Servicio de Urología, Hospital Nacional de Pediatría Profesor Dr. Juan P. Garrahan. Buenos Aires, Argentina. cristian.sager@gmail.com
authors.forename: C
authors.initials: C
authors.lastname: Sager
authors.forename: C
authors.initials: C
authors.lastname: Burek
authors.forename: V
authors.initials: V
authors.lastname: Durán
authors.forename: J P
authors.initials: JP
authors.lastname: Corbetta
authors.forename: S
authors.initials: S
authors.lastname: Weller
authors.forename: E
authors.initials: E
authors.lastname: Paz
authors.forename: J
authors.initials: J
authors.lastname: Bortagaray
authors.forename: J C
authors.initials: JC
authors.lastname: López
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A