Korean J Urol.  2014 Apr;55(4):281-287. 10.4111/kju.2014.55.4.281.

Intradetrusor Injections of Onabotulinum Toxin-A in Children With Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment

• Tarcan T
• Akbal C
• Sekerci CA
• Top T
• Simsek F

• KMID: 1885611
• DOI: http://doi.org/10.4111/kju.2014.55.4.281

Abstract

PURPOSE
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.
MATERIALS AND 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.

Keyword

Myelodysplastic syndromes; Neurogenic urinary bladder; Onabotulinum toxin-A; Overactive detrusor; Urinary incontinence

MeSH Terms

Anesthesia, General
Catheterization
Catheters
Child*
Compliance
Humans
Meningomyelocele
Muscarinic Antagonists
Myelodysplastic Syndromes
Prospective Studies
Urinary Bladder
Urinary Bladder, Neurogenic
Urinary Bladder, Overactive
Urinary Incontinence*
Urodynamics
Muscarinic Antagonists

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