Abstract | PURPOSE: We evaluated the effect of repeated intradetrusor injections of BTA in pediatric myelomeningocele not responding to medical management. MATERIALS AND METHODS: After baseline history, physical examination and urodynamic assessment BTA was injected (5 IU/kg body weight, maximum 300 IU) at 10 to 30 sites. Clinical and urodynamic assessment was performed at 3 months after each injection. Re-treatment was offered when clinical symptoms returned. RESULTS: A total of 20 patients (average age 13 years) received BTA injections. Of the patients 13 became continent. MBC increased from 215.6 +/- 58.8 cc to 338.3 +/- 98.4 cc (p < 0.01), MDP decreased from 43 +/- 13.7 cm H2O to 21.6 +/- 10.5 cm H2O (p < 0.01) and compliance increased from 5.2 +/- 2.6 ml/cm H2O to 13 +/- 6.9 ml/cm H2O (p < 0.01). At an average of 8.1 months after the first injection all 13 patients received a second injection, which led to similar improvement, ie MBC increased from 200.5 +/- 41.6 cc to 404.2 +/- 57.8 cc (p < 0.001), MDP decreased from 48.18 +/- 6.1 cm H2O to 27.8 +/- 3.7 cm H2O (p < 0.01) and compliance increased from 6.0 +/- 3.1 ml/cm H2O to 15.1 +/- 5.2 ml/cm H2O (p < 0.01). Among the responders 3 received 3 injections and 1 received 4 injections, all of whom exhibited improvement similar to that seen initially. Among our initial cohort of 20 patients 7 failed to improve initially and 6 failed to improve after a second injection. CONCLUSIONS: BTA seems to be a simple and safe way to postpone or avoid invasive procedures in two thirds of children with myelomeningocele not responding to usual medical treatment.
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Authors | W Altaweel, R Jednack, C Bilodeau, J Corcos |
Journal | The Journal of urology
(J Urol)
Vol. 175
Issue 3 Pt 1
Pg. 1102-5
(Mar 2006)
ISSN: 0022-5347 [Print] United States |
PMID | 16469632
(Publication Type: Journal Article)
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Chemical References |
- Neuromuscular Agents
- Botulinum Toxins, Type A
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Topics |
- Adolescent
- Adult
- Botulinum Toxins, Type A
(administration & dosage)
- Child
- Female
- Humans
- Injections, Intramuscular
(statistics & numerical data)
- Male
- Meningomyelocele
(complications)
- Neuromuscular Agents
(administration & dosage)
- Prospective Studies
- Urinary Bladder, Neurogenic
(drug therapy, etiology)
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