BERKELEY, CA (UroToday.com) - Children with idiopathic urge incontinence refractory to scheduled voiding and anticholonergics are a problematic group of patients.
The urodynamic studies on these patients show that botulin toxin-A (BTX-A) bladder injections effectively increased the bladder capacity and decreased uninhibited bladder contractions. Daytime wetting was reduced in most of the patients although some patients needed two or three therapy sessions.
In our present clinical practice, we perform an urodynamic study on all patients refractory to conventional wetting therapy. If detrusor overactivity is seen, TNS treatment is first started; if no response is found, BTX-A bladder injections are scheduled. Patients with partial or subsiding response on BTX-A may be treated with anticholinergics or with a higher dose of BTX-A at least six months after the first session. It is not necessary to repeat the urodynamic study since, according to our study, the effect of BTX-A on symptoms was not directly proportional to severity of overactive detrusor.
This study was rightfully criticized in that the post injection control urodynamic evaluations should have been performed at the same interval. The urodynamic test, however, is an unpleasant procedure because of its invasiveness. Thus, most of these non-neurologic patients were not motivated or willing to participate the control study before the effect of the treatment started to subside.
Tuija T. Lahdes-Vasama, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.