Botulinum Toxin a Injection in the M. Detrusor Vesicae Replaces Surgery in Children with Myelomeningocele

Synopsis of Video Botulinum Toxin A (BTxA) is used widespread in neurology and plastic surgery with very good results. Some groups used BTxA for the treatment of detrusor hyperreflexia in spinal cord injury. We propose BTxA in children with incomplete spinal lesion and detrusor hyperreflexia refractory to anticholinergic medication, where bladder augmentation is the only alternative. We enrolled 31 children with a mean age of 9.5 a (2.3-17.3) from 10/1999 to 09/2002. All patients had intolerable detrusor pressure over 40 cmH2O due to myelomeningocele (n=30) or spinal meningeoma (n=1), although they were on combined intravesical and oral anticholinergics. All patients used clean intermittent catheterization (CIC). BTxA injection was carried out under general anesthesia in a latex-free environment using a 21G Chiba needle to do the injections cystoscopically. We used 5-10 IE BTxA (Botox, Merz & Co., GmbH & Co, Dysport, Ipsen Pharma, Germany) ad 0,1ml NaCl per injection site at a total of 150 – 300 IU. The injections were distributed all over the bladder excluding the trigone.