Intravesical injection of botulinum toxin type A: Management of neuropathic bladder and bowel dysfunction in children with myelomeningocele

Kajbafzadeh, Abdol‐Mohammad; Moosavi, Seyed Amir; Tajik, Parvin; Arshadi, Hamid; Payabvash, Seyedmehdi; Salmasi, Amirali; Akbarī, Ḥamīd; Nejat, Farideh

doi:10.1016/j.urology.2006.05.056

Cited by 82 publications

(54 citation statements)

References 20 publications

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“…In addition, intravesical injection in children is performed using a rigid cystoscope with the patient under general anesthesia while EMDA technique is performed without anesthesia and on an outpatient basis. Our prior studies with intravesical BoNTA injection [2] and BoNTA/EMDA [1] showed considerable improvement in bladder and bowel function. In addition, the results of current study demonstrated that notable improvement occurred in both systems.…”

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confidence: 76%

Intravesical electromotive botulinum toxin type A administration for management of concomitant neuropathic bowel and bladder dysfunction in children

Kajbafzadeh

Sharifi‐Rad

Ladi‐Seyedian

2016

Int J Colorectal Dis

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Dear Editor: Myelomeningocele (MMC) is the most common congenital neurologic abnormality with an incidence of 1 in 1000 live births. Nearly 50 % of children with MMC have neuropathic detrusor overactivity (NDO) and detrusor sphincter dyssynergia. In addition, 75-92 % of these patients have a high frequency of neuropathic bowel problems including constipation, fecal incontinence, and abdominal pain which can complicate social integration and quality of life (QOL). The management of bladder and bowel dysfunction is important in MMC patients to protect renal function, establish patient autonomy, achieve continence, and improve social self-esteem. Botulinum toxin type A (BoNTA) uses as a highly effective treatment for MMC patients with NDO. Recently, injection of BoNTA into the internal anal sphincter has also been effectively used for treatment of persistent constipation in children and anal fissure in adults. Prior to introduction of BoNTA, many patients with neuropathic bladder and bowel dysfunction underwent invasive surgical procedures. Therefore, the use of BoNTA was indicated to avoid the need for invasive procedures by clinicians. Our prior study was the first report of intravesical electromotive BoNTA administration (BoNTA/ EMDA) in children with MMC and refractory NDO [1].Results showed a significant improvement in bowel dysfunction as well as bladder dysfunction. EMDA offers a noninvasive and relatively painless option for introducing the drug solution directly into the target site and preventing the side effects of oral and/or intravesical medications. Based on this information, the study was performed to confirm the effects of BoTNA/EMDA on management of concomitant bladder and bowel dysfunction in MMC patients.The local ethics committee at Tehran University of Medical Sciences approved the study protocol and written informed consents were then obtained from all participants. From May 2010 to Dec 2013, a total of 16 children with MMC and neuropathic bladder and bowel dysfunction were included in this prospective study. All patients had NDO and moderate to severe urinary incontinence (score 2 and 3) refractory to conventional treatment (demonstrating adverse effects or unsatisfactory success rate), requiring clean intermittent catheterization (CIC) every 3 to 4 h and use of a pad. Moreover, all patients had bowel dysfunction with irregular incomplete emptying of bowels and hard stools often associated with fecal soiling (Bristol Stool Form types 1, 3). Inclusion criteria were MMC patients older than 3 years with NDO and moderate to severe urinary incontinence in addition to bowel dysfunction including constipation often associated with soiling/ encopresis according to Rome III criteria. Urinary incontinence was categorized according to the scoring system defined by Schurch et al.: 0, completely dry; 1, wet once daily, usually at night; 2, wet <50 % of the time between catheterizations; and 3, wet >50 % of the time between catheterizations. Exclusion criteria included any evidence of coagulopathies, inflam...

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Intravesical electromotive botulinum toxin type A administration for management of concomitant neuropathic bowel and bladder dysfunction in children

Kajbafzadeh

Sharifi‐Rad

Ladi‐Seyedian

2016

Int J Colorectal Dis

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“…Durchschlagende Verbesserungen wurden in diesen Studien bzgl. der Kontinenz (durchschnittliche Abnahme um 61%), der maximalen zystometrischen Kapazität (durchschnittliche Zunahme um 80%) und des maximalen Detrusordruckes (durchschnittliche Abnahme um 44%) berichtet; zudem scheint sich nach der Therapie mit BoNT/A ein vesikoureteraler Reflux zurückzubilden [19]. [6,30].…”

Section: Ergebnisse Bei Neurogener Detrusorhyperaktivität Bei Kindernunclassified

Botulinum toxin for neurogenic bladder dysfunction

Schulte-Baukloh

2012

Urologe

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Botulinum neurotoxin (BoNT) has become increasingly established in the treatment of neurogenic bladder dysfunctions over the last 12 years. Today it represents an alternative to conservative medical therapy and reduces the indications for broader surgical measures. Since September 2011, BoNT/A is approved for the use in neurogenic bladder disorders. This article therefore summarises the main findings once more, particularly with regard to practical application.The by far most commonly used BoNT subtype is botulinum neurotoxin A (BoNT/A), which has shown the most convincing effects after detrusor injections in the urological field. It unfolds its full effect after about 7 days. Subjective parameters, such as urination frequency, incontinence and quality of life are improved most substantially, which is objectively reflected by the increase in bladder capacity and the reduction of maximum detrusor pressure. Significantly decreasing effectiveness and necessity for repeated injections must be expected after about 9 months. Repeated applications have proven to be effective. Systematic side effects are rare and do not reach dramatic extents. The major urologic side effect, which is not uncommon, is the increase in residual urine, which can lead to urinary retention in patients with spontaneous voiding.

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“…Eleven prospective observational studies in children show comparable efficacy. [25][26][27][28][29][30][31][32][33][34][35][36] Moreover, the results of pivotal licensing studies of onabotulinumtoxin A in NDO are currently being presented in abstract form and are showing a significant reduction in urgency incontinence episodes, improved urodynamic parameters, and improved QoL. [37][38][39][40] In the registration study presented at the European Association of Urology meeting in March 2011, a total of 154 patients with multiple sclerosis and 121 with spinal cord injury were randomized to receive onabotulinumtoxin A 200 U or 300 U or placebo.…”

Section: Botulinum Toxinmentioning

confidence: 99%

Systematic review of therapy for neurogenic detrusor overactivity

Fowler¹

2011

CUAJ

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While many neurologic diseases predispose patients to neurogenic detrusor overactivity (NDO), the only populations that have been systematically studied are adults with multiple sclerosis (MS), adults with spinal cord injury (SCI) and children and young adults with myelodysplasia. First-line pharmacotherapy for NDO is an antimuscarinic drug. However, the evidence base for these agents in this indication is poor. There is some high-quality evidence for the efficacy of detrusor injections of botulinum toxin A in the treatment of NDO, with significant reduction in urgency incontinence episodes, improved urodynamic parameters, and improved quality of life. While few adverse events have been reported with this therapy, there is a need for intermittent self-catheterization in these groups. N eurogenic detrusor overactivity (NDO) can be seen with various neurological diseases. At present, however, the only such populations that have been systematically studied are adults with multiple sclerosis (MS) and spinal cord injury (SCI) and children and young adults with myelodysplasia. There have yet to be any randomized, controlled studies evaluating therapy for NDO in Parkinson's Disease or dementia. This review will, therefore, focus on the available treatment evidence from the above-mentioned conditions. Antimuscarinic therapy for neurogenic detrusor overactivityThe first-line, mainstay treatment of NDO is the antimuscarinic drugs. This practice is not, however, based on a great deal of high quality research. Indeed, the body of evidence for their efficacy based on randomized controlled trials (RCTs) is surprisingly poor. In total, there are only five Grade-A studies in adults.1-5 These studies, which spanned from 1985 to 2007, examined the effect of oral propiverine, oxybutynin, trospium or propantheline or intravesical atropine. The research in MS has also been reviewed in a systematic fashion in a Cochrane review published in 2009. 6 In children with myelodysplasia, there are two RCTs 7,8 and 11 observational studies. 9-19Looking at all this evidence, propiverine, trospium, oxybutynin, propantheline and tolterodine have all been shown to produce clinical and some evidence of urodynamic improvement in NDO. Although this evidence is sufficient to conclude that "antimuscarinics are effective in NDO," prescribing more recently introduced antimuscarinics is not evidence-based. Rather, there is an assumption that their demonstrated efficacy in non-neurogenic DO is "carried over" to the NDO group. Indeed, everyday clinical experience does seem to bear that assumption out and even suggests that antimuscarinics may in fact be more efficacious in NDO than in idiopathic DO and that their benefits are longer lasting. Other oral therapies for neurogenic detrusor overactivity DesmopressinThe evidence for efficacy of desmopressin in MS for treatment of nocturia and daytime frequency is level 1, based on the results of a meta-analysis published in 2005. 20 However, desmopressin does carry the risk of hyponatremia, particularly ...

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Intravesical injection of botulinum toxin type A: Management of neuropathic bladder and bowel dysfunction in children with myelomeningocele

Cited by 82 publications

References 20 publications

Intravesical electromotive botulinum toxin type A administration for management of concomitant neuropathic bowel and bladder dysfunction in children

Intravesical electromotive botulinum toxin type A administration for management of concomitant neuropathic bowel and bladder dysfunction in children

Botulinum toxin for neurogenic bladder dysfunction

Systematic review of therapy for neurogenic detrusor overactivity

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