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A Simplified Technique for Botulinum Toxin Injections in Children With Neurogenic Bladder

2011; Lippincott Williams & Wilkins; Volume: 185; Issue: 6S Linguagem: Inglês

10.1016/j.juro.2011.01.037

1527-3792

Maria Paola Pascali, Giovanni Mosiello, Armando Marciano, Maria Luisa Capitanucci, Antonio Zaccara, M. De Gennaro,

Gastrointestinal motility and disorders

No AccessJournal of UrologyNeuropathic Bladder1 Jun 2011A Simplified Technique for Botulinum Toxin Injections in Children With Neurogenic Bladder Maria Paola Pascali, Giovanni Mosiello, Armando Marciano, Maria Luisa Capitanucci, Antonio Maria Zaccara, and Mario De Gennaro Maria Paola PascaliMaria Paola Pascali , Giovanni MosielloGiovanni Mosiello , Armando MarcianoArmando Marciano , Maria Luisa CapitanucciMaria Luisa Capitanucci , Antonio Maria ZaccaraAntonio Maria Zaccara , and Mario De GennaroMario De Gennaro View All Author Informationhttps://doi.org/10.1016/j.juro.2011.01.037AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Botulinum toxin type A has revolutionized the treatment of neurogenic bladder dysfunction. The original injection technique used a rigid cystoscope and a flexible collagen needle. To date botulinum toxin type A injection techniques have not been standardized. We present our experience in pediatric patients using a new flexible injection system. Materials and Methods: We treated 24 patients 3.8 to 17.5 years old who had neurogenic bladder dysfunction with botulinum toxin type A bladder and/or sphincter injection using a rigid cystoscope and the new N-DO™ endo-injector needle system. Another 24 patients 3.6 to 17.8 years old were treated with a 3.7Fr standard flexible needle and served as controls. Operative time, hospital stay, complications and efficacy were considered. Selection criteria and treatment were the same in the 2 groups. The 10 IU/kg dose was determined according to European Association of Urology guidelines. Results: All patients received botulinum toxin type A bladder injection while 11 patients in the endo-injector group and 5 controls also received urethral injection. In the endo-injector needle and control groups average operative time was 12.4 and 17.3 minutes for the bladder, and 5.1 and 10.1 minutes for the urethra, respectively (each p <0.05). All patients were discharged home the day after the procedure. No complications were observed. Urodynamics revealed an average maximum detrusor pressure decrease of 25 and 21 cm H2O, and an average bladder capacity increase of 75 and 80 ml in the endo-injector and control groups, respectively (p not significant). Conclusions: While retaining efficacy, the endo-injector needle technique appears to be more rapid than the standard procedure for botulinum toxin type A injection for neurogenic bladder dysfunction. Whether patients may be treated with sedation only remains to be clarified. References 1 : Botulinum toxin-A intradetrusor injections in children with neurogenic detrusor overactivity/neurogenic overactive bladder: A systematic literature review. J Pediatr Urol2009; 5: 156. 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Google Scholar Department of Nephro-Urology, Urodynamics and NeuroUrology Unit, Bambino Gesù Pediatric Hospital, Rome, Italy© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySchlomer B, Saperston K and Baskin L (2013) National Trends in Augmentation Cystoplasty in the 2000s and Factors Associated with Patient OutcomesJournal of Urology, VOL. 190, NO. 4, (1352-1358), Online publication date: 1-Oct-2013. Volume 185Issue 6SJune 2011Page: 2558-2562 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordsinjectionsurinary bladder, neurogenicendoscopyurethrabotulinum toxin type AAcknowledgmentsDr. Stefano Canu assisted with statistical analysis.MetricsAuthor Information Maria Paola Pascali More articles by this author Giovanni Mosiello More articles by this author Armando Marciano More articles by this author Maria Luisa Capitanucci More articles by this author Antonio Maria Zaccara More articles by this author Mario De Gennaro More articles by this author Expand All Advertisement PDF downloadLoading ...