PMID- 19154454
OWN - NLM
STAT- MEDLINE
DCOM- 20090528
LR  - 20101118
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 103
IP  - 9
DP  - 2009 May
TI  - Concomitant repeated intravesical injections of botulinum toxin-type A and 
      laparoscopic antegrade continence enema; a new solution for an old problem.
PG  - 1248-54
LID - 10.1111/j.1464-410X.2008.08287.x [doi]
AB  - OBJECTIVE: To report our experience of treating bladder and bowel dysfunction in 
      children with myelomeningocele, with simultaneous laparoscopic antegrade 
      continence enema (LACE) and repeated intravesical injection of botulinum 
      toxin-type A (BTX-A). PATIENTS AND METHODS: Six girls and 14 boys (mean age, 8.7 
      years) with myelomeningocele were included in this study. All patients had 
      received one or two intravesical injection(s) of BTX-A, but had persistent fecal 
      incontinence or constipation despite improved urinary symptoms. We performed a 
      two-port laparoscopic appendicostomy, immediately after repeated intravesical 
      injection of BTX-A, through a V-shaped skin flap at McBurney's point. The stoma 
      was finally covered by a quadrilateral skin flap, using the 'VQ' technique. The 
      degree of urinary incontinence and bowel dysfunction were determined in each 
      patient, and conventional urodynamic studies were performed 4 months after each 
      injection. RESULTS: All patients were followed-up for a mean (range) of 19.1 
      (14-33) months. Urinary continence improved significantly after the first 
      injection, and remained constant after repeat injections. The maximum detrusor 
      pressure, bladder compliance and capacity improved significantly (P < 0.001) 
      compared with baseline. Interestingly, the simultaneous intravesical BTX-A 
      injection/LACE procedure significantly improved all urodynamic variables compared 
      with the values obtained after the last BTX-A injection alone. The laparoscopic 
      procedure was well tolerated, and 19 (95%) children were nappy-free at the final 
      follow-up. Only two patients had stoma stenosis, and one patient had minor stoma 
      leakage. CONCLUSION: Concomitant repeat intravesical injection of BTX-A and LACE 
      can effectively manage bladder and bowel dysfunction in children with 
      myelomeningocele. The procedure may further contribute to improve bladder 
      urodynamic function, as effective evacuation of the bowel provides more room for 
      bladder distension.
FAU - Kajbafzadeh, AbdolMohammad
AU  - Kajbafzadeh A
AD  - Paediatric Urology Research Center, Department of Urology, Children's Hospital 
      Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
FAU - Mahboubi, Amir Hassan
AU  - Mahboubi AH
FAU - Payabvash, Seyedmehdi
AU  - Payabvash S
LA  - eng
PT  - Journal Article
DEP - 20081222
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
RN  - 0 (Neuromuscular Agents)
RN  - EC 3.4.24.69 (Botulinum Toxins, Type A)
SB  - IM
MH  - Administration, Intravesical
MH  - Adolescent
MH  - Botulinum Toxins, Type A/*administration & dosage
MH  - Child
MH  - Child, Preschool
MH  - Enema/*methods
MH  - Fecal Incontinence/complications/*therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - *Laparoscopy
MH  - Male
MH  - Meningomyelocele/complications/*therapy
MH  - Neuromuscular Agents/*administration & dosage
MH  - Treatment Outcome
MH  - Urinary Incontinence/complications/*drug therapy
EDAT- 2009/01/22 09:00
MHDA- 2009/05/29 09:00
CRDT- 2009/01/22 09:00
PHST- 2009/01/22 09:00 [entrez]
PHST- 2009/01/22 09:00 [pubmed]
PHST- 2009/05/29 09:00 [medline]
AID - BJU8287 [pii]
AID - 10.1111/j.1464-410X.2008.08287.x [doi]
PST - ppublish
SO  - BJU Int. 2009 May;103(9):1248-54. doi: 10.1111/j.1464-410X.2008.08287.x. Epub 
      2008 Dec 22.