Electromotive drug administration (EMDA) presents a minimally-invasive method of intravesical instillation of therapeutic agents without the need for general anesthesia 1. It employs a combination of iontophoresis, electrophoresis, and electroporation to deliver drugs into deep tissue layers using an electrical current created between two electrodes 2. This video shows feasibility of botulinum toxin type A (BoNTA) EMDA in myelomeningocele (MMC) children with urinary incontinence secondary to neuropathic detrusor overactivity.
In this technique (Video 1), catheterization was performed with a 10-Fr (CE-DAS, UROGENICS/ Ag 9900 (pediatric), Mirandola, Italy) catheter electrode, after providing a local transurethral anesthesia with 2% lidocaine gel. The cuff of the catheter was filled by 2cc saline solution. The bladder was then drained and irrigated with 0.9% saline solution until the catheter outflow became clear. The bladder was subsequently filled with sterile water to its maximal capacity. BoNTA (Dysport®) at a dose of 10 IU/kg was added to the intravesical solution. Negative electrode as two dispersive electrodes was placed on the abdomen. Positive electrode was connected to the intravesical catheter. A pulsed current generator (Physionizer 30, Physion srl, Mirandola, Italy), delivered a current with frequency of 2800 Hz, interval of 50 µs and amplitude of 10 - 20 mA for 20 minutes. At the end of the procedure, the bladder was emptied.
For the first time, BoNTA/EMDA was performed on MMC patients with urinary incontinence in our center 3. According to our prior reports, urinary incontinence improved in 75% of the patients between two consecutive clean intermittent catheterizations at 1-year follow-up 4. Mean maximal cystometric capacity significantly increased from 148 ± 62 mL at baseline to 239 ± 73 mL 1-year after the treatment 4.
This technique is a feasible, safe, reproducible, cost effective, long lasting and pain free method, on an outpatient basis with long-term duration of effects and without anesthesia or cystoscopy procedure.
Urology. 2019 Jul 09 [Epub ahead of print]
Lida Sharifi-Rad, Seyedeh-Sanam Ladi-Seyedian, Behnam Nabavizadeh, Maryam Alijani, Abdol-Mohammad Kajbafzadeh
Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Physical Therapy, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran., Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran., Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: .