746 HISTHOLOGICAL FEATURES IN BLADDER WALL IN CHILDREN WITH NEUROGENIC BLADDER DYSFUNCTION AFTER BOTULINUM TOXIN TYPE A INJECTIONS

Abstract

You have accessJournal of UrologyPediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfunction, Enuresis1 Apr 2010746 HISTHOLOGICAL FEATURES IN BLADDER WALL IN CHILDREN WITH NEUROGENIC BLADDER DYSFUNCTION AFTER BOTULINUM TOXIN TYPE A INJECTIONS Maria Paola Pascali, Giovanni Mosiello, Renata Boldrini, Maria Letizia Salsano, Armando Marciano, Enrico Castelli, and Mario De Gennaro Maria Paola PascaliMaria Paola Pascali More articles by this author , Giovanni MosielloGiovanni Mosiello More articles by this author , Renata BoldriniRenata Boldrini More articles by this author , Maria Letizia SalsanoMaria Letizia Salsano More articles by this author , Armando MarcianoArmando Marciano More articles by this author , Enrico CastelliEnrico Castelli More articles by this author , and Mario De GennaroMario De Gennaro More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1272AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the past ten years the urological use of botulinum toxin type A (BoNTA)has gained popularity in adults as in paediatric patients. The evidence base for its clinical use has been mainly from adult urology centres and trials, especially regarding long-term safety. Because the clinical use of BonTA for neurogenic bladder dysfunction (NBD) requires repeated injection during time, it seems essential to verify if repeated injections in children induce fibrosis over time or not. Up to now the histologic features of bladder wall after BoNTA injections was studied only in adults,this is the first report in pediatrics. METHODS The study was approved by local ethical and scientific committees and supported by National Ministry of Health, All patients were enrolled after written consent was obtained. On the basis of urodynamic data, patients with NBD not responding or not tolerating conventional treatment, with anticholinergics and clean intermittent catheterization, were treated with BoNTA. BoNTA injections into the detrusor were performed in general anaesthesia according to the technique described by Schurch, injecting 10 IU/KG, maximum 300 IU. Patients who repeated BoNTA injections had been treated 1 year earlier.Detrusor endoscopic cold cup biopsies were obtained from the posterolateral bladder wall 1.5-2 cm above one ureteral orifice. 3 criteria were chosen to examine the bladder wall: a)lymphocytic plasma cell inflammatory infiltration, b) oedema, c) fibrosis of the bladder wall. These criteria were evaluated considering 2 degrees: mild or strong. The criteria were compared in the 3 groups using Fischer's exact test (level of significance p< 0.05). RESULTS 27 Bladder wall specimen were obtained from 21 patients, aged 2-18 years old.3 clinical groups were identified: Group 1, 9 biopsies from patients immediately before the first BoNTA injection;, mean age 9.8 yrs, Group 2: 9 biopsies from patients at the second BoNTA injection, mean age 9.2 yrs,Group 3: 9 biopsies from patients with repeated multiple BoNTA injections (3-7 injections), mean age 11.3 yrs. Histhological alterations were present in all patients with NBD.Comparing the 2 degrees there was not statistically differences concerning inflammation and oedema as well as for fibrosis in the 3 groups. A mild fibrosis was present in the 67.8% group 1, 67.8% group2, 88.9% group 3. ( p>0.05). CONCLUSIONS Repeated injections of BoNTA into detrusor did not lead to increase fibrosis within the bladder wall in children too.This study confirmed the BoNTA long-term safety in pediatric urology. Rome, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e292 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Paola Pascali More articles by this author Giovanni Mosiello More articles by this author Renata Boldrini More articles by this author Maria Letizia Salsano More articles by this author Armando Marciano More articles by this author Enrico Castelli More articles by this author Mario De Gennaro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...