Editorial comment

Abstract

A growing body of reports has been exploring the effectiveness of BTX-A injected into the bladder to reduce overactivity secondary to neurogenic and inflammatory causes. These authors were the first to show the efficacy of this treatment in children with myelomeningocele and detrusor overactivity. 1 Schulte-Baukloh H. Michael T. Schobert J. et al. Efficacy of botulinum-A toxin in children with detrusor hyperreflexia due to myelomeningocele preliminary results. Urology. 2002; 59: 325-328 Abstract Full Text Full Text PDF PubMed Scopus (170) Google Scholar Their current investigative work on the longer term and repeated use of BTX-A in these same children is an exhaustive study that reveals its progressive salutary effects on detrusor function. Apparently, with each set of injections, the positive effects of Botox lasts an increasing longer period. Although this mode of therapy holds promise for these children, the total toxic dose of the toxin and the exact number and proper location of the injections within the detrusor still need investigation. It is also important to decipher exactly how this neurotoxin works to reduce detrusor overactivity, whether it blocks afferent signals from the detrusor or paralyzes the muscle in response to efferent stimuli. The increasing application of BTX-A should prompt more investigative work in these areas. Regardless, for those children who are, or become, refractory to, or intolerant of, anticholinergic medication, this form of therapy holds promise, as long as it does not produce long-term side effects from repeated injections. Perhaps it might be possible to incorporate BTX-A in microspheres that slowly allow the agent to leach into the detrusor to provide an even longer effective period of response. Repeated botulinum-A toxin injections in treatment of children with neurogenic detrusor overactivityUrologyVol. 66Issue 4PreviewTo assess the long-term success of treatment with repeated botulinum-A toxin (BTX-A; Botox) injections into the detrusor muscle for neurogenic detrusor overactivity in children. Full-Text PDF