Endoscopic Botulinum Toxin Injection for Refractory Enuresis Based on Urodynamic Assessment
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to determine the urodynamic characteristics of refractory enuresis and explored whether those characteristics can be managed through differential endoscopic injections with botulinum toxin. Methods: In total, 27 patients with nonmonosymptomatic enuresis who showed no response after conservative treatment for more than 12 months were included. The patients then underwent a videourodynamic study and received a differential endoscopic injection of botulinum toxin on the same day. Reduced capacity, detrusor overactivity, and bladder neck widening were the 3 major abnormal findings assessed during the filling phase, while sphincter hyperactivity was the only abnormality assessed during the emptying phase. An intravesical or intrasphincteric injection of botulinum toxin was attempted according to the videourodynamic study findings. Follow-up was conducted at 1, 3, 6, and 12 months after treatment. Results: The median age was 10 years (range, 7–31 years). Although 19 and 8 patients had a preoperative diagnosis of overactive bladder or dysfunctional voiding, respectively, the urodynamic diagnosis was different in more than half of the patients. Those showing detrusor overactivity benefited from intravesical botulinum toxin injection, whereas those with only sphincter hyperactivity benefited from both intravesical and intrasphincteric injections. Treatment resistance to botulinum toxin seemed to be attributable to bladder neck widening. Time had no apparent effect on efficacy, which persisted 6 months after the injection. More than 80% of the patients maintained the benefits of the injection after 1 year. Conclusions: Videourodynamic studies were useful for identifying the reasons underlying refractory nonmonosymptomatic enuresis and helpful for determining the appropriate site of botulinum toxin injection.
Abstract
Purpose: This study aimed to determine the urodynamic characteristics of refractory enuresis and explored whether those characteristics can be managed through differential endoscopic injections with botulinum toxin. Methods: In total, 27 patients with nonmonosymptomatic enuresis who showed no response after conservative treatment for more than 12 months were included. The patients then underwent a videourodynamic study and received a differential endoscopic injection of botulinum toxin on the same day. Reduced capacity, detrusor overactivity, and bladder neck widening were the 3 major abnormal findings assessed during the filling phase, while sphincter hyperactivity was the only abnormality assessed during the emptying phase. An intravesical or intrasphincteric injection of botulinum toxin was attempted according to the videourodynamic study findings. Follow-up was conducted at 1, 3, 6, and 12 months after treatment. Results: The median age was 10 years (range, 7–31 years). Although 19 and 8 patients had a preoperative diagnosis of overactive bladder or dysfunctional voiding, respectively, the urodynamic diagnosis was different in more than half of the patients. Those showing detrusor overactivity benefited from intravesical botulinum toxin injection, whereas those with only sphincter hyperactivity benefited from both intravesical and intrasphincteric injections. Treatment resistance to botulinum toxin seemed to be attributable to bladder neck widening. Time had no apparent effect on efficacy, which persisted 6 months after the injection. More than 80% of the patients maintained the benefits of the injection after 1 year. Conclusions: Videourodynamic studies were useful for identifying the reasons underlying refractory nonmonosymptomatic enuresis and helpful for determining the appropriate site of botulinum toxin injection.
참고문헌 (26)
- Yeung CK, "Differences in characteristics of nocturnal enuresis between children and adolescents : a critical appraisal from a large epidemiological study", BJU Int, 97, pp.1069~1073 (2006)
- Theunis M, "Self-image and performance in children with nocturnal enuresis", Eur Urol, 41, pp.660~667 (2002)[DOI]
- Vande Walle J, "Practical consensus guidelines for the management of enuresis", Eur J Pediatr, 171, pp.971~983 (2012)
- Franco I, "Evaluation and treatment of nonmonosymptomatic nocturnal enuresis : a standardization document from the International Children’s Continence Society", J Pediatr Urol, 9, pp.234~243 (2013)
- Glassberg KI, "Nonneurogenic voiding disorders in children and adolescents : clinical and videourodynamic findings in 4 specific conditions", J Urol, 184, pp.2123~2127 (2010)
- Kaufman MR, "High yield of urodynamics performed for refractory nonneurogenic dysfunctional voiding in the pediatric population", J Urol (2006)
- Anding R, "When should video and EMG be added to urodynamics in children with lower urinary tract dysfunction and is this justified by the evidence? ICI-RS 2014", Neurourol Urodyn, 35, pp.331~335 (2016)
- Hjalmas K, "Urinary incontinence in children : suggestions for definitions and terminology", Scand J Urol Nephrol Suppl, 141, pp.1~6 (1992)[DOI]
- Parekh DJ, "The use of radiography, urodynamic studies and cystoscopy in the evaluation of voiding dysfunction", J Urol, 165, pp.215~218 (2001)
- Ballek NK, "Lower urinary tract dysfunction in childhood", Urol Clin North Am, 37, pp.215~228 (2010)
- Hoebeke P, "The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor", J Urol, 176, pp.328~330 (2006)[DOI]
- Mokhless I, "Botulinum A toxin urethral sphincter injection in children with nonneurogenic neurogenic bladder", J Urol, 176, pp.1767~1770 (2006)[DOI]
- Bauer SB, "International Children’s Continence Society standardization report on urodynamic studies of the lower urinary tract in children", Neurourol Urodyn, 34, pp.640~647 (2015)
- Wen JG, "ICS educational module : cystometry in children", Neurourol Urodyn, 37, pp.2306~2310 (2018)
- ‘t Hoen LA, "Breaking the vicious circle : onabotulinum toxin A in children with therapy-refractory dysfunctional voiding", J Pediatr Urol, 11, pp.119~ (2015)
- Vricella GJ, "Longterm efficacy and durability of botulinum-A toxin for refractory dysfunctional voiding in children", J Urol, 191, pp.1586~1591 (2014)
- Austin PF, "The standardization of terminology of lower urinary tract function in children and adolescents : update report from the standardization committee of the International Children’s Continence Society", Neurourol Urodyn, 35, pp.471~481 (2016)
- Rittig N, "Outcome of a standardized approach to childhood urinary symptoms-long-term follow-up of 720 patients", Neurourol Urodyn, 33, pp.475~481 (2014)
- Bael A, "The relevance of urodynamic studies for urge syndrome and dysfunctional voiding : a multicenter controlled trial in children", J Urol, 180, pp.1486~1493 (2008)[DOI]
- van Gool JD, "Multi-center randomized controlled trial of cognitive treatment, placebo, oxybutynin, bladder training, and pelvic floor training in children with functional urinary incontinence", Neurourol Urodyn, 33, pp.482~487 (2014)
- Soygur T, "The role of video-urodynamic studies in managing non-neurogenic voiding dysfunction in children", BJU Int, 93, pp.841~843 (2004)
- Elmissiry M, "Refractory enuresis in children and adolescents : how can urodynamics affect management and what is the optimum test", J Pediatr Urol, 9, pp.348~352 (2013)
- Yeung CK, "Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis", J Urol, 162, pp.1049~1054 (1999)[DOI]
- Glassberg KI, "Can children with either overactive bladder or dysfunctional voiding transition from one into the other : are both part of a single entity", J Pediatr Urol, 12, pp.217.e1~217.e8 (2016)
- Bauer SB, "Pelvic floor laxity : a not so rare but unrecognized form of daytime urinary incontinence in peripubertal and adolescent girls", J Pediatr Urol, 14, pp.544.e1~544.e7 (2018)
- Dobrowolska-Glazar BA, "Open and laparoscopic colposuspension in girls with refractory urinary incontinence", Front Pediatr, 5, pp.284~ (2017)