Efficacy of botulinum-a toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary results

Urology. 2002 Mar;59(3):325-7; discussion 327-8. doi: 10.1016/s0090-4295(01)01641-7.

Abstract

Objectives: The established treatment of children with neurogenic bladder consists of the use of anticholinergic drugs, such as oxybutynin and tolterodine, and clean intermittent catheterization four or five times a day. If anticholinergic drugs and clean intermittent catheterization fail, surgery is often necessary. With the intent of avoiding surgery, we investigated the effect of botulinum-A toxin for treating detrusor hyperreflexia in this group of patients.

Methods: The subjects were 17 children (average age 10.8 years) who had detrusor hyperreflexia and were using clean intermittent catheterization four or five times a day. Urodynamic studies were followed by injection of 85 to 300 U of botulinum-A toxin into 30 to 40 sites in the detrusor muscle. Urodynamic follow-up was done 2 to 4 weeks after injection.

Results: The mean reflex volume increased by 112.1%, from 95.00 plus minus 34.54 mL (range 47 to 147) to 201.45 plus minus 68.57 mL (range 77 to 310) (P <0.005). The maximal bladder capacity increased by 56.5%, from 137.53 plus minus 59.96 mL (range 59 to 242) to 215.25 plus minus 96.36 mL (range 60 to 380) (P <0.005). The maximal detrusor pressure decreased by 32.6%, from 58.94 plus minus 32.32 cm H(2)O (range 19 to 149) to 39.75 plus minus 26.12 cm H(2)O (range 7 to 100) (P <0.005). Detrusor compliance increased by 121.6%, from 20.39 plus minus 26.5 mL/cm H(2)O (range 4.5 to 40) to 45.18 plus minus 45.4 mL/cm H(2)O (range 5.3 to 100) (P <0.01).

Conclusions: Botulinum-A toxin injection into the hyperreflexive detrusor muscle seems to be very effective and might be a therapeutic alternative to anticholinergic drugs.

Publication types

  • Clinical Trial

MeSH terms

  • Botulinum Toxins, Type A / administration & dosage*
  • Child
  • Compliance
  • Female
  • Follow-Up Studies
  • Humans
  • Injections, Intramuscular
  • Male
  • Meningomyelocele / complications*
  • Muscle Hypertonia / drug therapy*
  • Muscle Hypertonia / etiology
  • Muscle Hypertonia / physiopathology
  • Prospective Studies
  • Urinary Bladder, Neurogenic / drug therapy*
  • Urinary Bladder, Neurogenic / etiology
  • Urinary Bladder, Neurogenic / physiopathology
  • Urodynamics / drug effects

Substances

  • Botulinum Toxins, Type A