Voiding Function and DysfunctionIntravesical Injections of Botulinum Toxin Type A for Management of Neuropathic Bladder: A Comparison of Two Methods
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Material and Methods
An interventional, single-center, prospective, double-blind, randomized study was conducted to assess the efficacy and durability of botulinum toxin type A injections in detrusor alone vs injections in both detrusor and external urethral sphincter. Children with MMC who attended a medical center in Tehran from August 2007 to September 2008 were the patients in this study.
General Findings
The study included 60 patients with MMC in whom we had no success on previous management with anticholinergic medications and clean intermittent catheterization, hyper-reflexive neurogenic bladder, vesicourethral reflux, and urinary incontinency, from August 2007 to September 2008. Using block randomization, all patients were assigned to one of the treatment groups.
The mean age (± standard deviation) for group A was 6.58 years (± 2.53) and 6.71 years (± 3.23) for group B. There were no
Comment
Neuropathic bladder abnormalities in patients with MMC require treatment for preservation of the upper urinary tract, bladder continence, autonomy, and social integration. The mainstay of treatment includes clean intermittent catheterization and anticholinergic medication for urinary incontinency. A minority of children will not respond to conservative therapy and will ultimately require surgical intervention. We have previously reported our surgical experience in the management of neuropathic
Conclusions
In conclusion, botulinum toxin type A intravesical injections seem to be safe and partially effective in patients with MMC and nonresponders to medical management and our results point toward a better short-term outcome for intradetrusal and intrasphincter injections together compared with intradetrusal injections.
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Disease-Specific Outcomes of Botulinum Toxin Injections for Neurogenic Detrusor Overactivity
2017, Urologic Clinics of North AmericaAn updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders
2014, European UrologyCitation Excerpt :The limited number of studies presenting comparable data meant there were minimal comparisons to be made between the high and low LE studies in children for OAB and DSD. However, three LE 2 studies showed significant improvements in children with NDO in terms of improvement in MCC by 50% and a reduction in MDP by 50% [32–34]. The data on children still remains of low quality; higher LE studies are necessary before more definitive conclusions can be reached.
Evidence-based review and assessment of botulinum neurotoxin for the treatment of urologic conditions
2013, ToxiconCitation Excerpt :The technique for administration was transperineal injection under cystoscopic guidance. The Class I study and one of the Class II studies (de Seze et al., 2002; Gallien et al., 2005) used a dose of 100 U of A/Ona, one Class II study (Dykstra and Sidi, 1990) used doses of 140 and 240 U of A/Ona, and one Class II study (Safari et al., 2010) involving children with myelomeningocele compared two doses of A/Abo: 10 U/kg into bladder vs. 8 U/kg into bladder plus 2 U/kg into external urethral sphincter. The Dykstra study was deemed Class II because only 5 patients were studied and no rationale for administering two doses in the active-treatment arm was provided.
A clinical observation of the use of botulinum toxin in a patient with neurogenic detrusor overactivity
2023, Advances in Health and Disease. Volume 77Urinary incontinence in geriatric patients: Diagnosis and therapy
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This project has been supported by a research grant from Tehran University of Medical Sciences.
Abdol-Mohammad Kajbafzadeh, Hamid Arshadi and Farideh Nejat take the responsibility for data integrity and accuracy and both were involved in patient selection, management, and data acquisition. Saeed Safari and Sarah Jamali were involved in study management and conducting blind allocation. They also reviewed the manuscript content for intellectual content. Peiman Habibollahi analyzed and interpreted the data and drafted the manuscript.