Intradetrusor Injections of Onabotulinum Toxin-A in Children With Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment
Tarcan Tufan, Akbal Cem, Sekerci Cagrı A., Top Tuncay, Simsek Ferruh,
소속 상세정보
( Tarcan Tufan )
Turkey Marmara University School of Medicine Department of Urology
( Akbal Cem )
Marmara University School of Medicine Department of Urology
( Sekerci Cagrı A. )
Turkey Marmara University School of Medicine Department of Urology
( Top Tuncay )
Turkey Marmara University School of Medicine Department of Urology
( Simsek Ferruh )
Turkey Marmara University School of Medicine Department of Urology
KMID : 0358320140550040281
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.
키워드
Myelodysplastic syndromes; Neurogenic urinary bladder; Onabotulinum toxin-A; Overactive detrusor; Urinary incontinence
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