title: [Endoscopic management of urinary incontinence in neurogenic bladder due to spinal cord lesions in children].
abstract: BACKGROUND
  The urological management of urinary incontinence in neurogenic bladder due to spinal cord lesions in children is intended to achieve social continence while preserving the upper urinary tract, combining clean intermittent catheterization with anticholinergic agents. The objective of this study was to report the results on continence of endoscopic management of bladder and/or sphincter of children with failure or intolerance to first intention therapy.
  
  
  METHODS
  Of the 364 children followed for neurologic bladder in our institution, 22 required endoscopic management between 2000 and 2012. Urinary incontinence was related to detrusor overactivity in 16 children and sphincter deficiency in 13 children, requiring one or several intradetrusor injections of botulinium toxin-A (BTA) and/or dextranomer/hyaluronic acid (Dx/Ha) injection in the bladder neck. Continence was reassessed between six and eight weeks after the last injection using the Schulte-Baukloh score.
  
  
  RESULTS
  At the end of the mean follow-up of four years, 16 children received 54 injections of BTA and 13 children had 24 injections of Dx/Ha. Social continence, defined as a score between 0 and 1, was acquired quickly after injection of BTA and required to repeat the injections every 8.7 months (6-12) with a very low morbidity. After the first injection of Dx/Ha, 69% of the children improved significantly their incontinence score (from 1 to 0 or from 2 or 3 to 1) with better results for girls.
  
  
  CONCLUSIONS
  An appropriate endoscopic management has enabled an improvement of the continence of two-thirds of children who fail first intention treatment for their neurogenic bladder. This is an alternative to delay or avoid major surgery.
authors.affiliation: Service de chirurgie viscérale pédiatrique et néonatale, hôpital Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France.
authors.forename: C
authors.initials: C
authors.lastname: Dariane
authors.affiliation: Service de chirurgie viscérale pédiatrique et néonatale, hôpital Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France; UFR de médecine Pierre-et-Marie-Curie, UPMC université Paris 06, 75005 Paris, France; Inserm UMRS_933, service de cytogénétique et d'embryologie médicales, hôpital Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 75571 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Peycelon
authors.affiliation: UFR de médecine Pierre-et-Marie-Curie, UPMC université Paris 06, 75005 Paris, France; Unité pédiatrique de médecine physique et de rééducation (MPR), hôpital Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 75571 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Lallemant
authors.affiliation: UFR de médecine Pierre-et-Marie-Curie, UPMC université Paris 06, 75005 Paris, France; Unité pédiatrique de médecine physique et de rééducation (MPR), hôpital Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 75571 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Forin
authors.affiliation: Service de chirurgie viscérale pédiatrique et néonatale, hôpital Trousseau, hôpitaux universitaires Est Parisien, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75571 Paris cedex 12, France; UFR de médecine Pierre-et-Marie-Curie, UPMC université Paris 06, 75005 Paris, France. Electronic address: georges.audry@trs.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Audry
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D003558:Cystoscopy; D003911:Dextrans / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D013118:Spinal Cord Diseases / Q000150:complications; D001750:Urinary Bladder, Neurogenic / Q000150:complications; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D003911:Dextrans; D009465:Neuromuscular Agents; C487487:dextranomer-hyaluronic acid copolymer; D006820:Hyaluronic Acid; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin type A; Children; Copolymère d’acide hyaluronique/dextranomère; Dextranomer based implants; Dextranomer/hyaluronic acid copolymer; Enfants; Implants de dextranomère; Incontinence urinaire; Neurogenic urinary bladder; Toxine botulique A; Urinary incontinence; Vessie neurologique