Efficacy of botulinum-A toxin in children with detrusor hyperreflexia due to myelomeningocele: Preliminary results

Objectives. The established treatment of children with neurogenic bladder consists of the use of anticholinergic drugs, such as oxybutynin and tolterodine, and clean intermittent catheterization four or five times a day. If anticholinergic drugs and clean intermittent catheterization fail, surgery is often necessary. With the intent of avoiding surgery, we investigated the effect of botulinum-A toxin for treating detrusor hyperreflexia in this group of patients. Methods. The subjects were 17 children (average age 10.8 years) who had detrusor hyperreflexia and were using clean intermittent catheterization four or five times a day. Urodynamic studies were followed by injection of 85 to 300 U of botulinum-A toxin into 30 to 40 sites in the detrusor muscle. Urodynamic follow-up was done 2 to 4 weeks after injection. Results. The mean reflex volume increased by 112.1%, from 95.00+/-34.54 mL (range 47 to 147) to 201.45+/-68.57 mL (range 77 to 310) (P<0.005). The maximal bladder capacity increased by 56.5%, from 137.53 +/- 59.96 mL (range 59 to 242) to 215.25 +/- 96.36 mL (range 60 to 380) (P<0.005). The maximal detrusor pressure decreased by 32.6%, from 58.94+/-32.32 cm H2O (range 19 to 149) to 39.75+/-26.12 cm H2O (range 7 to 100) (P<0.005). Detrusor compliance increased by 121.6%, from 20.39 +/- 26.5 mL/cm H2O (range 4.5 to 40) to 45.18 +/- 45.4 mL/cm H2O (range 5.3 to 100) (P<0.01). Conclusions. Botulinum-A toxin injection into the hyperreflexive detrusor muscle seems to be very effective and might be a therapeutic alternative to anticholinergic drugs. UROLOGY 59: 325-328, 2002. (C) 2002, Elsevier Science Inc.