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Preoperative urodynamic factors predicting outcome of botulinum toxin-A intradetrusor injection in children with neurogenic detrusor overactivity.

Authors
 Sang Woon Kim  ;  Jae Hyeok Choi  ;  Yong Seung Lee  ;  Sang Won Han  ;  Young Jae Im 
Citation
 UROLOGY, Vol.84(6) : 1480-1484, 2014 
Journal Title
 UROLOGY 
ISSN
 0090-4295 
Issue Date
2014
MeSH
Botulinum Toxins, Type A/therapeutic use* ; Child ; Child, Preschool ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Injections, Intralesional ; Male ; Multivariate Analysis ; Predictive Value of Tests ; Preoperative Care/methods ; Retrospective Studies ; Risk Assessment ; Treatment Outcome ; Urinary Bladder, Neurogenic/diagnosis ; Urinary Bladder, Neurogenic/drug therapy* ; Urinary Bladder, Neurogenic/surgery ; Urinary Bladder, Overactive/diagnosis ; Urinary Bladder, Overactive/drug therapy* ; Urinary Bladder, Overactive/surgery ; Urodynamics
Abstract
OBJECTIVE: To investigate urodynamic (UD) parameters that predict outcome of intradetrusor botulinum toxin-A (BTX-A) injection in children with neurogenic detrusor overactivity (NDO), by reviewing clinical and UD data. METHODS: From January 2010 to March 2014, 56 cases of the first BTX-A intradetrusor injection were performed in pediatric patients with NDO. We excluded 19 cases based on these criteria: patient age <4 years, no preoperative UD study or postoperative outcome assessment, and simultaneous sphincter injection. Based on the Patient Global Impression of Improvement, patients were classified as responders or nonresponders. RESULTS: Thirty-seven cases were included finally. Mean number of pads used per day was significantly decreased after BTX-A injection (2.67 ± 1.46 vs 1.37 ± 1.15; P <.001). On postoperative UD study, maximum cystometric capacity and residual urine volume were significantly increased above baseline. Persistent NDO was only detected in 3 cases (8.1%). Regardless of UD improvements, 20 cases were responders, whereas 17 were nonresponders based on Patient Global Impression of Improvement. Preoperative bladder compliance was significantly lower in nonresponders (25.11 ± 32.59 vs 8.64 ± 6.52; P = .039). Open bladder neck (OBN) was seen in 9 cases and more likely occurred in nonresponders. Regression analysis revealed that poor bladder compliance (<10 mL/cm H2O; odds ratio, 6.041; 95% confidence interval, 1.189-30.677; P = .030) and presence of OBN (odds ratio, 16.889; 95% confidence interval, 1.825-156.282; P = .031) were independent predictors of poor response after BTX-A injection. CONCLUSION: Preoperative bladder compliance and OBN were important predictors of outcome after BTX-A intradetrusor injection. Thus, intradetrusor BTX-A injection should be considered in select patients to achieve optimal outcome.
Full Text
http://www.sciencedirect.com/science/article/pii/S0090429514009765
DOI
10.1016/j.urology.2014.09.001
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sang Woon(김상운) ORCID logo https://orcid.org/0000-0002-5790-1948
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Im, Young Jae(임영재)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/138979
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