Intradetrusor onabotulinum-a toxin injections in children with therapy-resistant idiopathic detrusor overactivity. A retrospective study.

INTRODUCTION AND OBJECTIVE: The use of intravesical onabotulinum-A toxin (BoNT-A) injections in the treatment of idiopathic detrusor overactivity has been widely studied in adults [2-5]. However, in pediatric populations, study groups are small, and results are not yet sufficient to support this treatment as a standard practice. The aim of this study is to determine the effectiveness and safety of this treatment in children with non-neurogenic detrusor overactivity, resistant to conservative therapy. MATERIAL AND METHODS: We retrospectively evaluated the effect and safety of the intradetrusor injection of 100 Units (U) of BoNT-A in 257 children with therapy-resistant non-neurogenic detrusor overactivity between May 2003 and August 2017. Outcome parameters were the number of daytime incontinence and enuresis episodes per week and bladder capacity (BC). Treatment outcomes were classified into complete response, partial response, or no response. RESULTS: The database includes 257 children, of which are 102 girls and 155 boys. Median age of first BoNT-A injection was 8 years (range 4-18 years). Of the patients with enuresis, daytime incontinence or both, a complete response was seen in 50%, 45.7%, and 17%, respectively. BC was significantly higher after the first, second, and third injection of 100 U BoNT-A. We estimated that the mean duration of the effect of an injection with a dose of 100 U is around 12 months. After the first injection, one girl (0.4%) developed urinary retention, which required temporary clean intermittent catheterization (CIC). Seventeen patients (6.6%) developed a urinary tract infection. In three patients (1.2%), postoperative vesicoureteral reflux was seen. DISCUSSION: A distinction between the effect on daytime incontinence and enuresis was made. A poorer effect on enuresis in children who suffered from both conditions was observed. Drawbacks of this study are its retrospective design and the lack of anticholinergic treatment standardization before and after BoNT-A injection. CONCLUSION: BoNT-A injection is a potentially effective adjuvant therapy in the treatment of children with therapy-resistant overactive bladder (OAB). Bladder capacity increases significantly after the first, second, and third injections. A better effect on daytime incontinence than on enuresis was seen. Prospective randomized trials with standardization of conservative treatment and symptoms questionnaires are necessary to confirm the beneficial effect of BoNT-A injections on BC and incontinence.

Prostatic Leiomyoma: A Case Report.

A pure leiomyoma of the prostate is a rare tumor. Less than 30 cases about prostatic leiomyoma have been reported. Pathologic anatomy examination is the only medium for definitive diagnosis and is important to rule out malignancies such as leiomyosarcoma. We describe an accidental finding of a tumor in the right prostate lobe of a 54 year old man, who was diagnosed with prostatic leiomyoma and treated with open radical prostatectomy.

Ablative Intravesical Chemotherapy for Small Recurrent Non-Muscle-Invasive Bladder Cancer: A Prospective Study.

OBJECTIVE: The efficacy of intravesical chemotherapy in abolishing small papillary recurrences of non-muscle-invasive bladder cancer (NMIBC), the disease-free interval in responders and patients' preferences were explored. METHODS: When a small (≤1 cm) papillary recurrence of a NMIBC was diagnosed, the patient could choose between immediate transurethral resection of the bladder (TURB) or four weekly intravesical instillations with mitomycin C (MMC) or epirubicin (ERC). Control cystoscopy was scheduled 2-3 weeks after the last instillation. Complete remission was defined as total disappearance of all papillary tumours and negative cytology. RESULTS: 25 patients with 47 recurrence episodes were recruited from February 2003 until August 2011. The median follow-up was 35 months. After exclusion of 2 patients with intolerance to the instillations, 45 study episodes could be analysed. All patients to whom this was proposed preferred the instillations over immediate TURB. Complete, partial and no response was seen in 23 (51%), 6 (13%) and 16 (36%) out of 45 episodes, respectively. The median disease-free interval after complete remission was 16 months (95% confidence interval 9-24). CONCLUSIONS: Small papillary recurrences of NMIBC completely disappear in about half of the cases receiving four weekly bladder instillations with MMC or ERC. This is followed by a disease-free interval. Intravesical chemotherapy was preferred by all patients over immediate TURB.