Léon Priscilla, Jolly Catherine, Binet Aurélien, Fiquet Caroline, Vilette Christine, Lefebvre Francis, Bouché-Pillon-Persyn Marie-Agnès, Poli-Mérol Marie-Laurence
Pediatric Surgery Department, American Hospital, CHU de Reims, France.
Pediatric Surgery Department, American Hospital, CHU de Reims, France.
J Pediatr Surg. 2014 Sep;49(9):1424-8. doi: 10.1016/j.jpedsurg.2014.04.004. Epub 2014 May 14.
Non-neurogenic detrusor overactivity in children leads to varying degrees of functional impairments (urinary urgency, pollakiuria, urge incontinence, nocturia). Botulinum toxin has shown its effectiveness in the management of detrusor overactivity in neurological patients.
To evaluate the relevance of intravesical Botulinum toxin injections for the treatment of non-neurogenic overactive bladders in children. These pediatric patients were resistant to all the usual therapeutics (e.g. bladder/bowel rehabilitation, anticholinergic drugs, management of diet/hygiene habits and constipation, percutaneous posterior tibial nerve stimulation).
8 children (mean age: 12.5years), 5 girls, 3 boys with daytime and/or nighttime incontinence and non-neurogenic detrusor overactivity validated by urodynamic testing. Urodynamic testing was conducted before the injections as well as 6weeks and 1year post injections. We used Dysport® 8 Speywood Units/kg injected via cystoscopy into 25 different sites.
We noted improvements without any complaints during bladder voiding for all patients, in 6 patients the overactivity disappeared after 1 injection. Compliance was improved early-on in half the cases and at 1year for all cases (from 12% to 61%, p=0.01). Noninhibited contractions decreased constantly in both frequency and intensity. Clinical symptoms improved: mean of 7.75 daytime urinary incontinence episodes (IE) per week before the injection vs. 3 after the procedure (p=0.04). For nighttime IE the improvement was even more noticeable with 7.38 nighttime IE episodes per week before the injection vs. 2.06 after the procedure (p=0,02).
Intradetrusor Botulinum toxin injections are a potential therapeutic option for the management of non-neurogenic detrusor overactivity in children resistant to the usual treatments.
儿童非神经源性逼尿肌过度活动会导致不同程度的功能障碍（尿急、尿频、急迫性尿失禁、夜尿症）。肉毒杆菌毒素已在神经疾病患者逼尿肌过度活动的治疗中显示出有效性。
评估膀胱内注射肉毒杆菌毒素治疗儿童非神经源性膀胱过度活动症的相关性。这些儿科患者对所有常规治疗（如膀胱/肠道康复、抗胆碱能药物、饮食/卫生习惯及便秘管理、经皮胫后神经刺激）均有抵抗。
8名儿童（平均年龄：12.5岁），5名女孩，3名男孩，有白天和/或夜间尿失禁，经尿动力学测试证实为非神经源性逼尿肌过度活动。在注射前以及注射后6周和1年进行尿动力学测试。我们通过膀胱镜将8斯皮伍德单位/千克的Dysport®注射到25个不同部位。
我们注意到所有患者在膀胱排尿期间均有改善且无任何不适，6名患者在1次注射后过度活动消失。半数病例早期顺应性得到改善，所有病例在1年时顺应性均得到改善（从12%提高到61%，p = 0.01）。无抑制性收缩在频率和强度上均持续下降。临床症状改善：注射前每周白天尿失禁发作平均7.75次，术后为3次（p = 0.04）。对于夜间尿失禁发作，改善更为明显，注射前每周7.38次夜间尿失禁发作，术后为2.06次（p = 0.02）。
对于常规治疗有抵抗的儿童非神经源性逼尿肌过度活动，膀胱内注射肉毒杆菌毒素是一种潜在的治疗选择。
