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(PP)
FIVE YEARS FOLLOW-UP OF INTRAVESICAL ELECTROMOTIVE BOTULINUM TOXIN
TYPE A ADMINISTRATION FOR MANAGEMENT OF NEUROPATHIC DETRUSOR
OVERACTIVITY IN CHILDREN
Abdol-Mohammad KAJBAFZADEH, Lida SHARIFI-RAD and Seyedeh-Sanam LADI-SEYEDIAN1
Tehran University of Medical Science, Pediatric Center of Excellence, Section of Tissue Engineering and Stem Cell
Therapy, Tehran, IRAN (ISLAMIC REPUBLIC OF)
PURPOSE
To investigated the long-term efficacy and success rate of intravesical electromotive botulinum toxin type A (BTX-A)
administration in myelomeningocele (MMC) patients who had urinary incontinence due to neuropathic detrusor
overactivity (NDO).
MATERIAL AND METHODS
Twenty four MMC patients (mean age: 8.8 years, range: 3-18) were included in the study and followed up for 5 years.
Using an electrode bladder catheter, 10 IU/kg of BTX-A was inserted into the bladder for electromotive drug
administration (EMDA) without anesthesia and as outpatient basis. The EMDA equipment was connected to the electrode
of indwelling catheter and 2 dispersive electrodes, a pulsed current generator delivered 10 mA for 20 minutes. The
preliminary assessments were voiding diary, urodynamic study (UDS), kidney, bladder ultrasound and
cystourethrography then annually.
RESULTS
Prior to the treatment, all patients had refractory NDO and urinary incontinence. During the follow up, 6/24 (25%) ,
7/24(29.1%) and 3/24(12.5%) of patients needed to repeat EMDA after 1, 2 and 3 years, respectively, while remaining
8 (33.3%) patients were completely dry between CICs at 5 years follow-up. Mean maximum detrusor pressure
significantly decreased and mean maximum bladder capacity increased at follow-up (P<0.05). Reflux was resolved in
80% of patients.
CONCLUSIONS
The results of present study have shown that EMDA/BTX-A is a feasible, safe, reproducible, cost benefit and pain free
method as an outpatient's basis with long-term effects and no need for anesthesia and cystoscopy. This novel delivery
system resulted in considerable improvement in the UDS parameters, urinary incontinence, and VUR in patients with
refractory NDO.