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Trigonal injection of botulinum toxin‐A does not cause vesicoureteral reflux in neurogenic patients
Author(s) -
Mascarenhas Frederico,
Cocuzza Marcello,
Gomes Cristiano Mendes,
Leão Nilo
Publication year - 2008
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.20515
Subject(s) - medicine , vesicoureteral reflux , botulinum toxin , trigonal crystal system , reflux , urology , surgery , disease , crystal structure , chemistry , crystallography
Abstract Aims We evaluated the effect of botulinum toxin type A (BTX‐A) injections in the trigone on the antireflux mechanism and evaluated its short‐term efficacy. Materials and Methods Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX‐A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics. Results At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX‐A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271±92 to 390±189 ml (p=0.002), reflex volume varied from 241±96 to 323±201 ml (p=0.020) and maximum detrusor pressure reduced from 66±39 to 38±37 cm H 2 O (p<0.001). Conclusions Our results confirm the safety of trigone injections of BTX‐A in terms of development of VUR and upper urinary tract damage. Whether they are beneficial for patients with NDO or other causes of voiding dysfunction will need further studies. Neurourol. Urodynam. 27:311–314, 2008. © 2007 Wiley‐Liss, Inc.