Indications et résultats des injections intradétrusoriennes de toxine botulique type A chez l’enfant

Abstract

The authors report their experience of intradetrusor injections of botulinum toxin type A (TBA) in children. This treatment was deliberately limited to patients with acquired neurogenic bladder, high detrusor pressures and urinary incontinence despite anticholinergic therapy. Six children with a mean age of 11.6 years (range: five to 18 years) treated by intermittent catheterization presented an indication for intradetrusor injection of TBA. One half of these patients presented recurrent urinary tract infections. Their leak point pressure was greater than or equal to 40 cmH(2)O (mean: 67+/-33.6) and the bladder capacity of these children was less than the capacity predicted for age (mean: 68%+/-32.8). TBA was injected into 20 to 30 sites by cystoscopy at a dose of 12 IU/kg of body weight (maximum dose: 300 IU). No adverse effects were observed. Only one child still presented incontinence, but only during urinary tract infections. Four children were able to stop their anticholinergic treatment. Two months after the injection, all children had normal detrusor pressures (mean: 24.2+/-7.4 cmH(2)O). The maximum cystomanometric capacity then exceeded the predicted capacity (113%+/-22). In acquired neurogenic bladder with detrusor hyperactivity, TBA protects the upper urinary tract (by decreasing detrusor pressures) and controls urinary incontinence (by increasing the functional bladder capacity), without preventing subsequent bladder augmentation.