Botulinum-A Toxin Injection Into the Detrusor: A Safe Alternative in the Treatment of Children With Myelomeningocele With Detrusor Hyperreflexia

Riccabona, M.; Koen, Mark; Schindler, Monica; Beckers, Goedele M.A.; Pycha, Armin; Lusuardi, Lukas

doi:10.1097/01.ju.0000108892.35041.2d

Cited by 171 publications

(108 citation statements)

References 16 publications

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“…The therapeutic concept therefore is to convert the overactive into an underactive detrusor by adequate pharmacotherapy and to assist or accomplish bladder emptying by intermittent (self-) catheterization with the advantage of dry intervals between. In case that this situation cannot be managed conservatively, botulinum A toxin injections into the detrusor [Schulte-Baukloh et al, 2002;Riccabona et al, 2004], bladder augmentation or sphincterotomy (with the risk for even increased incontinence) and sometimes the implantation of an arti¢cial urinary sphincter should be considered. Overactive detrusor with underactive/acontractile sphincter results in detrusor overactivity incontinence combined with stress incontinence due to the decreased outlet resistance.…”

Section: Discussionmentioning

confidence: 98%

Predictive value of initial urodynamic pattern on urinary continence in patients with myelomeningocele

Kessler

Lackner

Kiss

et al. 2006

Neurourology and Urodynamics

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Section: Discussionmentioning

confidence: 98%

Predictive value of initial urodynamic pattern on urinary continence in patients with myelomeningocele

Kessler

Lackner

Kiss

et al. 2006

Neurourology and Urodynamics

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“…3 However, there are several limitations to this treatment, including drug-related side effects, urethral damage and recurrent urinary tract infections, which can significantly diminish the patient's quality of life. 4 Electrical stimulation has been introduced as another treatment option for urinary incontinence caused by NDO.…”

Section: Introductionmentioning

confidence: 99%

Early low-frequency stimulation of the pudendal nerve can inhibit detrusor overactivity and delay progress of bladder fibrosis in dogs with spinal cord injuries

Liu

Chen

et al. 2013

Spinal Cord

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Objectives: To determine the inhibitory effects of pudendal nerve stimulation (5 Hz) on bladder overactivity at the early stage of spinal cord injury (SCI) in dogs, and to explore the possible effects on delayed progression of bladder fibrosis after SCI. Methods: The study was performed using six dogs with spinal cord transection at the T9-T10 level. Group 1 (three dogs) underwent low-frequency electrical stimulation of the pudendal nerve 1 day after spinal cord transection. Group 2 (three dogs) underwent only spinal cord transection. All dogs underwent urodynamic examination at 1 and 3 months after SCI. The bladders were removed for histological examination of fibrosis at 3 months after SCI. Results: Bladder capacity and compliance were significantly increased (Po0.05) by pudendal nerve stimulation in group 1 when compared with group 2 at 1 and 3 months after SCI. Non-voiding contractions (NVCs) were inhibited in group 1 compared with group 2. Collagen fibers were significantly increased and elastic fibers were significantly decreased (Po0.05) in group 2 when compared with group 1. Conclusion: Early low-frequency pudendal nerve stimulation can inhibit detrusor overactivity (DO), increase bladder capacity and delay the progression of bladder fibrosis.

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“…Since the introduction of clean intermittent catheterization (CIC) as a safe method of bladder emptying for patients with voiding dysfunction, 1 a urinary management of MMC patients has been dramatically improved. Currently, many MMC patients, who perform CIC and take anticholinergic pharmacotherapy and intravesical injection of botulinum toxin 2,3 as conservative therapies, obtain low-pressure urinary storage with adequate capacity and socially acceptable continence between catheterization.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of lower urinary and bowel function in meningomyelocele patients with augmentation enterocystoplasty

et al. 2008

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Objectives: We evaluated the outcomes of augmentation ileocystoplasty in video-urodynamics (V-UDS) and questionnaires related to bowel and urinary function. Methods: In 22 meningomyelocele (MMC) patients (11 male and 11 female, a mean age at surgery 14.4 years) who underwent augmentation ileocystoplasties, V-UDS was performed before and at a median of 15 months (6-120 months) after the surgery and the questionnaires were answered at a median of 7.1 years (1.1-14.5 years) after surgery. Results: Concomitant procedures of urethral sling in four, cecostomy in four and ureteral reimplantation in two were performed at augmentation ileocystoplasty. V-UDS showed a significant improvement after the surgery in bladder capacity, bladder compliance and detrusor overactivity. Vesicoureteral reflux (VUR) disappeared after the surgery in 16 of 19 ureters with VUR. Although questionnaire for urinary condition using International Consultation on Incontinence QuestionnaireShort Form demonstrated that 80% of patients were completely free from urinary incontinence after surgery, more than a half of patients had persistent or deteriorated bowel function such as urgency of bowel movement and fecal incontinence in questionnaires for bowel function. Even with complaints in bowel function, more than 80% of MMC patients had a high level of satisfaction with augmentation enterocystoplasty in overall quality of life (QOL). Conclusions: Benefits of augmentation ileocystoplasty were maintained in urodynamic parameters as well as urinary continence. Although augmentation ileocystoplasty generally provides high QOL for MMC patients refractory to conservative therapies, an advance of fecal management can make MMC patients' QOL superior to a current state.

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Botulinum-A Toxin Injection Into the Detrusor: A Safe Alternative in the Treatment of Children With Myelomeningocele With Detrusor Hyperreflexia

Abstract: Botulinum-A toxin is a safe alternative in the management of detrusor hyperreflexia in children with MMC. The preliminary results regarding urodynamic parameters and continence have been promising.

Cited by 171 publications

References 16 publications

Predictive value of initial urodynamic pattern on urinary continence in patients with myelomeningocele

Predictive value of initial urodynamic pattern on urinary continence in patients with myelomeningocele

Early low-frequency stimulation of the pudendal nerve can inhibit detrusor overactivity and delay progress of bladder fibrosis in dogs with spinal cord injuries

Outcomes of lower urinary and bowel function in meningomyelocele patients with augmentation enterocystoplasty

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