Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstract for Reference 77

of 'Management of bladder dysfunction in children'

Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding.
Petronijevic V, Lazovic M, Vlajkovic M, Slavkovic A, Golubovic E, Miljkovic P
J Urol. 2007;178(6):2599.
PURPOSE: We investigated the role of botulinum toxin type A and urotherapy in the treatment of children with dysfunctional voiding.
MATERIALS AND METHODS: Nine female children with dysfunctional voiding refractory to standard urotherapy and alpha1-adrenergic blocking agents were included in the prospective clinical study. Botulinum toxin type A in a dose of 500 units was injected transperineally into the external urinary sphincter. Bladder rehabilitation was introduced 2 weeks after botulinum toxin type A treatment. Uroflow studies with ultrasound residual urine volumes were obtained before and 6 months after treatment. All children were tested before and 6 months after treatment using the empirically designed International Reflux Study in Children modified questionnaire.
RESULTS: After treatment the mean +/- SD voided volume increased from 180 +/- 73 to 228 +/- 94 ml (p<0.05) while post-void residual urine volume decreased from 52 +/- 40 to 19 +/- 18 ml (p<0.05). Significant differences in other uroflowmetry parameters were not found. However, significant symptom score improvement was detected 6 months after treatment, being decreased by 7 vs 20 (p<0.01). No systemic side effects occurred following botulinum toxin type A injection.
CONCLUSIONS: Our study demonstrates that the voiding mechanism in children with dysfunctional voiding refractory to standard therapy can be significantly improved and maintained at least 6 months after combined botulinum toxin type A injection and bladder rehabilitation.
Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Nis, Serbia. petvesna@eunet.yu