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Botulinum toxin application in children with overactive and/or spastic detrusor – preliminary report
Article published in Urologia Polska 2008/61/4.


Janusz Sulisławski, Wiesław Urbanowicz
Klinika Urologii Dziecięcej Collegium Medicum Uniwersytetu Jagiellońskiego


children neurogenic bladder detrusor overactivity botulinum toxin


Neurogenic disorders of the urinary bladder in children are in most cases due to myelomeningocele. Standard therapy is
not effective in about 10% patients. These cases require surgical procedures such as urinary bladder augmentation. These procedures
are associated with surgical and metabolic complications.

The aim of the study.
This is a preliminary report of the use of botulinum toxin in children “resistant” to standard therapy with type
III neurogenic urinary bladder.

Material and methods.
Among 212 children with neurogenic bladder, classical therapy was not effective in 20 cases. All these
cases were children with type III neurogenic bladder. In these cases botulinum toxin A was injected into detrusor at 10-12 U/ kg b.w.
dose, but the total dose did not exceed 300 U. Therapeutic effects was assessed by cystometric investigations performed monthly
throughout a 9 month period. Moreover, control VCUG was executed after 3 months. T-test for relative variables was used for statistical
evaluation of the obtained parameters.

Type A botulinum toxin is safe and do not provokes any side effects. Statistically, it results in the improvement of cystometric
investigation parameters. Temporary action of the BTx A present the limitation of this treatment method. Its use allows to
postpone the decision concerning extensive surgical procedure – urinary bladder augmentation in children.


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Janusz Sulisławski
Klinika Urologii Dziecięcej
ul. Wielicka 265
30-663 Kraków
tel. (012) 657 21 31