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Tufan Tarcan,Cem Akbal,Çağrı A. Şekerci,Tuncay Top,Ferruh Şimşek 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.4
Purpose: This was a prospective single-arm study to assess the efficacy and safety ofintradetrusor injections of onabotulinum toxin-A in children with urinary incontinenceassociated with neurogenic detrusor overactivity due to myelomeningocele. All patientshad failed the first-line treatment of a combination of oral antimuscarinics andintermittent catheterization. Materials and Methods: The study group consisted of 31 children with myelomeningocelewith a mean age of 7.95 years (range, 5–13 years) who were followed up for a meanof 29 weeks. The amount of onabotulinum toxin A injected was 10 U/kg with a maximaldose of 300 U. There were 20 to 30 injection sites with rigid cystoscopic guidance undergeneral anesthesia. Results: Thirty of 31 patients reported dryness between intermittent catheterizationintervals. The mean reduction in maximum detrusor pressure and the mean increasein maximum cystometric capacity from baseline were 53% and 51.5%, respectively, 6weeks after injection. We found a 324% increase in mean bladder compliance and a 57%increase in mean intermittent catheterization volumes. The mean duration of efficacywas 28 weeks with a single injection and 36 weeks for repeated injections (minimum,16 weeks; maximum, 52 weeks). The mean time interval between repeated onabotulinumtoxin-A injections was 7 months (maximum, 13 months). Intradetrusor injectionsof onabotulinum toxin-A were well tolerated. Conclusions: Onabotulinum toxin-A injections into the bladder wall provide a significantsymptomatic and urodynamic improvement in children with neurogenic detrusoroveractivity due to myelomeningocele who are on intermittent catheterization. The treatment seems to be safe and very well tolerated.
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