%0 Journal Article
%T Pharmacotherapy in Pediatric Neurogenic Bladder Intravesical Botulinum Toxin Type A
%A Cristian Sager
%A Carol Burek
%A Victor Dur¨˘n
%A Juan Pablo Corbetta
%A Santiago Weller
%A Bortagaray Juan
%A Juan Carlos L¨®pez
%J ISRN Urology
%D 2012
%R 10.5402/2012/763159
%X When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as an alternative. The neurotoxin type A reduces bladder pressure and increases its capacity and wall compliance. Additionally, it contributes to improving urinary continence and quality of life. This novel therapy is ambulatory with a low incidence of adverse effects. Due to its transitory effect, it is necessary to repeat the injections in order to sustain its therapeutic effect. In these review article we talk about Mechanism of Action, Indications, effects, administration and presentations of the Botulinum Neurotoxin Type A in pediatric patients. Also, we make references to controversial issues surrounding its use. A bibliographic search was done selecting articles and revisions from Pubmed. The key words used were botulinum toxin A, neurogenic bladder, and children. The search was limited to patients younger than 18 years of age and reports written in English in the past ten years. 1. Introduction This is a review of published work. In most cases, the neurogenic bladder in children is sequela of spinal dysraphism. Less frequent causes include sacral anomalies and traumatic and tumoral lesions of the nervous system. Children with open dysraphism can present different patterns of behavior in the lower urinary tract. In the case of bladders with high risk of upper urinary tract deterioration, it is essential to confirm the presence of overactivity of the detrusor muscle, with reduction in bladder capacity and urinary incontinence; in other cases, reduced compliance is involved. Detrusor-sphincter dyssynergia (DSD) can be present in 50% of the cases. If it is not treated, it represents and important risk factor, since it will naturally lead to the development of ureterohydronephrosis in over 70% of cases, and vesicoureteral reflux in 80% of cases, with renal parenchyma deterioration [1, 2]. To achieve a urinary reservoir of adequate capacity, low storage and voiding pressure becomes the main goal. In this way, it is possible to preserve the upper urinary tract undamaged. Then, the focus of attention lies on achieving urinary continence and improving the quality of life of these patients. The classical treatment for the neurogenic bladder in children consists of clean intermittent catheterization (CIC) programs and administration of anticholinergic drugs. Approximately, 90% of patients respond well to this type of therapeutic scheme [3, 4]. However, a percentage of patients, which should not be underestimated, are refractory to this program or develop
%U http://www.hindawi.com/journals/isrn.urology/2012/763159/