title: Intradetrusor Injections of Onabotulinum Toxin-A in Children With Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment.
abstract: OBJECTIVE
  This was a prospective single-arm study to assess the efficacy and safety of intradetrusor injections of onabotulinum toxin-A in children with urinary incontinence associated with neurogenic detrusor overactivity due to myelomeningocele. All patients had failed the first-line treatment of a combination of oral antimuscarinics and intermittent catheterization.
  
  
  METHODS
  The study group consisted of 31 children with myelomeningocele with a mean age of 7.95 years (range, 5-3 years) who were followed up for a mean of 29 weeks. The amount of onabotulinum toxin A injected was 10 U/kg with a maximal dose of 300 U. There were 20 to 30 injection sites with rigid cystoscopic guidance under general anesthesia.
  
  
  RESULTS
  Thirty of 31 patients reported dryness between intermittent catheterization intervals. The mean reduction in maximum detrusor pressure and the mean increase in maximum cystometric capacity from baseline were 53% and 51.5%, respectively, 6 weeks after injection. We found a 324% increase in mean bladder compliance and a 57% increase in mean intermittent catheterization volumes. The mean duration of efficacy was 28 weeks with a single injection and 36 weeks for repeated injections (minimum, 16 weeks; maximum, 52 weeks). The mean time interval between repeated onabotulinum toxin-A injections was 7 months (maximum, 13 months). Intradetrusor injections of onabotulinum toxin-A were well tolerated.
  
  
  CONCLUSIONS
  Onabotulinum toxin-A injections into the bladder wall provide a significant symptomatic and urodynamic improvement in children with neurogenic detrusor overactivity due to myelomeningocele who are on intermittent catheterization. The treatment seems to be safe and very well tolerated.
authors.affiliation: Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Tufan
authors.initials: T
authors.lastname: Tarcan
authors.affiliation: Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Akbal
authors.affiliation: Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Cağri A
authors.initials: CA
authors.lastname: Sekerci
authors.affiliation: Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Tuncay
authors.initials: T
authors.lastname: Top
authors.affiliation: Division of Pediatric Urology, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
authors.forename: Ferruh
authors.initials: F
authors.lastname: Simşek
keywords: Myelodysplastic syndromes; Neurogenic urinary bladder; Onabotulinum toxin-A; Overactive detrusor; Urinary incontinence
references.citation: J Urol. 2006 Mar;175(3 Pt 1):1102-5
references.pmid: 16469632
references.citation: Eur Urol. 2012 May;61(5):928-35
references.pmid: 22078337
references.citation: J Urol. 1994 Nov;152(5 Pt 1):1582-5
references.pmid: 7933209
references.citation: J Urol. 1981 Aug;126(2):205-9
references.pmid: 7196460
references.citation: Eur Urol. 2006 May;49(5):908-13
references.pmid: 16458416
references.citation: J Urol. 2007 Dec;178(6):2593-7; discussion 2597-8
references.pmid: 17945300
references.citation: Eur Urol. 2011 Oct;60(4):742-50
references.pmid: 21798658
references.citation: J Urol. 2006 Jul;176(1):314-24
references.pmid: 16753432
references.citation: Eur J Paediatr Neurol. 2006 Sep-Nov;10(5-6):215-25
references.pmid: 17097905
references.citation: Urol Clin North Am. 1993 Aug;20(3):485-504
references.pmid: 8351774
references.citation: J Urol. 2010 Dec;184(6):2423-8
references.pmid: 20952003
references.citation: Urology. 2006 Nov;68(5):1091-6; discussion 1096-7
references.pmid: 17113899
references.citation: Urology. 2002 Mar;59(3):325-7; discussion 327-8
references.pmid: 11880062
references.citation: J Pediatr Urol. 2012 Oct;8(5):497-503
references.pmid: 22115699
references.citation: J Urol. 2006 Oct;176(4 Pt 2):1706-11
references.pmid: 16945628
references.citation: J Urol. 2012 Jun;187(6):2131-9
references.pmid: 22503020
references.citation: J Urol. 2004 Feb;171(2 Pt 1):845-8; discussion 848
references.pmid: 14713840
references.citation: Urology. 2005 Oct;66(4):865-70; discussion 870
references.pmid: 16230156
references.citation: Eur Urol. 2003 Jul;44(1):139-43
references.pmid: 12814690
references.citation: J Pediatr Urol. 2009 Jun;5(3):156-64
references.pmid: 19264554