ABSTRACT
OBJECTIVE: To evaluate clinical and urodynamic efficiency of onabotulinumtoxinA (Botox) treatment in pediatric patients with urinary incontinence due to neurogenic overactive bladder. PATIENTS AND METHODS: Seventeen patients aged from 6 to 17 years (median 11 years) were treated with Botox injections. Clinical response to incontinence, duration of the response, and urodynamic results before and 1-3 months after treatment were evaluated. RESULTS: Mean incontinence frequency decreased significantly (p = 0.036); six of 17 patients had >90% reduction, and a further three patients had a 50-90% reduction in incontinence episodes. Median duration of the response was 15 months (range 3-42 months). Mean bladder volume changed from 380 ± 148 ml to 453 ± 147 (p = 0.078), maximal detrusor pressure decreased from 45 ± 31 cmH2O to 32 ± 21 cmH2O (p = 0.030), and the number of patients with detrusor contractions during filling decreased from 12 to three (p = 0.005) after the treatment. The patients with poor bladder compliance had either no response or a short duration of response. At follow-up eight patients had undergone bladder augmentation because of persistent incontinence. CONCLUSIONS: About one third of pediatric patients with neurogenic bladder had a good response to Botox treatment. In many patients, the clinical response was longer than expected. The patients who initially had poor bladder compliance had a poor response to the treatment.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Urinary Bladder, Neurogenic/diagnosis , Urinary Bladder, Neurogenic/drug therapy , Urinary Incontinence/drug therapy , Urodynamics/physiology , Administration, Intravesical , Adolescent , Botulinum Toxins, Type A/adverse effects , Child , Cystoscopy/methods , Databases, Factual , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Finland , Follow-Up Studies , Humans , Male , Retrospective Studies , Risk Assessment , Severity of Illness Index , Treatment Outcome , Urinary Bladder, Neurogenic/complications , Urinary Incontinence/diagnosis , Urinary Incontinence/etiologyABSTRACT
Antibodies to liver specific lipoprotein (ALSP) were determined in the blood of 76 children suffering from virus hepatitis A, 22 children with virus hepatitis B and 30 normal children (controls) by enzyme-binding immunosorption for the elucidation of relationships between autoimmunization to hepatic cell plasma membranes and the course of the disease. The results showed ALSP to be present in 25-27% of the examined subjects, being of prognostic importance for the detection of protracted or chronic forms of virus hepatitis.
