title: Effect of Botox injection at the bladder neck in boys with bladder dysfunction after valve ablation.
abstract: OBJECTIVE
  After posterior urethral valve ablation, some boys are still have a hostile bladder. We conducted a prospective randomized study to determine if Botox injection at the bladder neck will help improve vesical dysfunction in this subgroup of boys or not.
  
  
  METHODS
  Twenty boys with history of posterior urethral valve ablation and severe bladder dysfunction with a mean age of 16 months were studied. Cases were further randomized into two groups. Group I (study group) had endoscopic injection of a single dose of 100 IU of Botox into the hypertrophied bladder neck at 3, 6, and 9 o'clock. Group II (control group) patients with the same parameters had urethroscopy to exclude residual valves. Both groups had the standard conservative treatment. Cases were followed after 6 months of initiating the management protocol. This includes laboratory studies (urine culture and sensitivity, blood urea nitrogen, serum creatinine), ultrasound of the urinary tract. Voiding cysto-urethrogram and urodynamic study (pressure flow study).
  
  
  RESULTS
  There was no statistical difference in both groups regarding rate of urinary tract infection, improvement of hydronephrosis, resolution of vesico-ureteral reflux, creatinine level at the start or at the end of the study. Urodynamic parameters revealed an increase in cystometric capacity in both groups at the end of the study but without statistical difference. The mean voiding pressure reduced significantly in both groups but without statistical difference.
  
  
  CONCLUSIONS
  Temporarily abolishing the effect of bladder neck by Botox injection does not seem to improve the outcome of those boys who had a severe voiding dysfunction after valve ablation.
authors.affiliation: Department of Urology, University of Alexandria School of Medicine, Alexandria, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mokhless
authors.affiliation: Department of Urology, University of Alexandria School of Medicine, Alexandria, Egypt.
authors.forename: Abdel-Rahman
authors.initials: AR
authors.lastname: Zahran
authors.affiliation: Department of Urology, University of Alexandria School of Medicine, Alexandria, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Saad
authors.affiliation: Department of Urology, University of Alexandria School of Medicine, Alexandria, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Yehia
authors.affiliation: Department of Urology, University of Alexandria School of Medicine, Alexandria, Egypt. Electronic address: Mohamed.youssif@alexmed.edu.eg.
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Youssif
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002675:Child, Preschool; D003558:Cystoscopy; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D017211:Treatment Failure; D014522:Urethral Diseases / Q000473:pathology / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Bladder dysfunction; Bladder neck; Botox; Posterior urethral valves; Valve bladder