title: Repeated injections of intradetrusor onabotulinumtoxinA as adjunctive treatment of children with neurogenic bladder.
abstract: OBJECTIVE
  To evaluate the effects of repeated injections of onabotulinumtoxinA in children with neurogenic bladders refractory to conventional treatment.
  
  
  METHODS
  A total of 26 children with neurogenic bladder were prospectively studied. Some patients received up to four repeat injections. Patients were reinjected if they showed improvement in voiding diary, score of urinary incontinence and/or urodynamic studies; otherwise, augmentation cystoplasty was indicated.
  
  
  RESULTS
  Of the 26 patients, 12 were reinjected a second time, 6 patients were reinjected a third time and 2 patients received a repeat injection for the fourth time. Six months after the first, second and third injection, the urinary incontinence score 0 (dry) was 50, 77 and 75 %, respectively. After each injection, the mean bladder capacity in voiding diary and the mean maximum cystometric capacity increased. The mean detrusor pressure at the end of filling decreased. Only compliance after the first injection improved significantly. Detrusor overactivity (n: 4), improved during 3 months and reappeared in three children after the first injection, but at greater cystometric volumes. In the fourth case, it reappeared 11 months after the third injection. Five patients underwent cystoplasty.
  
  
  CONCLUSIONS
  After treatment with onabotulinumtoxinA, urinary continence achieved was 50-77 %. There were favorable changes in urodynamic variables, but they were insufficient. Detrusor overactivity was attenuated, but did not disappear completely.
authors: Cristian
authors: C
authors: Sager
authors: Carol
authors: C
authors: Burek
authors: Juan
authors: J
authors: Bortagaray
authors: Juan Pablo
authors: JP
authors: Corbetta
authors: Santiago
authors: S
authors: Weller
authors: Victor
authors: V
authors: Durán
authors: Juan Carlos
authors: JC
authors: Lopez
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019233:Retreatment; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy / Q000209:etiology; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A
references: J Urol. 1994 Nov;152(5 Pt 1):1582-5
references: 7933209
references: Arch Phys Med Rehabil. 1990 Jan;71(1):24-6
references: 2297305
references: J Urol. 2004 Feb;171(2 Pt 1):845-8; discussion 848
references: 14713840
references: J Urol. 2011 Jun;185(6 Suppl):2552-7
references: 21527192
references: ANZ J Surg. 2010 Apr;80(4):250-3
references: 20575951
references: Cir Pediatr. 2011 Jan;24(1):38-43
references: 23155649
references: Toxicon. 2000 Feb;38(2):245-58
references: 10665805
references: Eur Urol. 2005 May;47(5):653-9
references: 15826758
references: BJU Int. 1999 Mar;83 Suppl 2:42-7
references: 10210604
references: Eur Urol. 2009 Jan;55(1):100-19
references: 18823697
references: J Urol. 2000 Sep;164(3 Pt 1):692-7
references: 10953127
references: J Urol. 1981 Aug;126(2):205-9
references: 7196460
references: Headache. 2003 Jul-Aug;43 Suppl 1:S16-24
references: 12887390
references: Urology. 2002 Mar;59(3):325-7; discussion 327-8
references: 11880062
references: Prog Urol. 2007 May;17(3):352-7
references: 17622058
references: J Pediatr Urol. 2009 Jun;5(3):156-64
references: 19264554
references: Urology. 2010 Jul;76(1):233-7
references: 20451970
references: Eur Urol. 2006 Apr;49(4):644-50
references: 16426734