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Combined endoscopic approach for the treatment of urinary incontinence of neurologic origin in children

M. Haddad¹, G. Karsenty², G. Hery¹, D. Planche¹ , JM. Guys¹

¹La Timone Children Hospital, Marseille ;

²Sainte Margueritte Hospital, Marseille, France



Introduction: We report the results of a prospective study evaluating the clinical efficiency of a combined endoscopic treatment (intradetrusor botulin toxin and silicone gel in the neck of the urinary bladder) for urinary incontinence of neurological origin in children.

Material and methods: Since December 2007, we included patients with neurologic bladders under intermittent catheterization that were non-responsive or had little response to anticholinergic medication. All patients received a Botox injection (12 U/kg, max. 300 U) in the detrussor associated or not with a Macroplastic injection in the neck of the bladder (2-3 ml). A monthly follow-up over the telephone, a urodynamic evaluation, micturition calendars and a visual satisfaction scale were performed at 2, 6 and 9 months. The clinical efficiency was analyzed through the need to wear dipers and the duration of continence between 2 catheterizations.

Results: 12 patients (7 boys), most of which had spina bifida, mean age 10 years (6-16 years) were included. The mean follow-up was 11.55 months (5-16 months). In 4 patients we noted a total dissapearing of the leaks (33%), in 7 patients an improvement (less leakage) (58%) and in 1 patient failure (no change). The efficiency of the injections was established between 1 and 12 days (4.7 days average) after the injection and lasted on average 5.1 months. The urodynamic results are correlated with these clinical findings. The global average of treatment satisfaction is 6.36/10. Out of the 8 combined treatment patients, 1 is a success, 7 improved at 1 month, 5 remained improved at 2 months and 1 at 6 months.

Conclusion: If the intradetrusor injection of toxin had a beneficial effect on urinary incontinence, its combination with the injection of the neck of the urinary bladder is feasible but, surprisingly, brings no demonstrable improvement of results at 6 months.


Key words: urinary incontinence, neurologic bladders, prospective study, endoscopic treatment, botulin toxin, silicone gel