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Biardeau X, Haddad R, Chesnel C, Charlanes A, Hentzen C, Turmel N, Campagne S, Capon G, Fatton B, Gamé X, Jeandel C, Kerdraon J, Mares P, Mezzadri M, Petit AC, Peyronnet B, Soler JM, Thuillier C, Deffieux X, Robain G, Amarenco G, Manceau P. [Use of botulinum toxin A in pelvic floor dysfunctions in the elderly: A review]. Prog Urol 2019; 29:216-225. [PMID: 30621961 DOI: 10.1016/j.purol.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The present article is the final report of a multi-disciplinary meeting supported by the GRAPPPA (group for research applied to pelvic floor dysfunctions in the elderly). The objective was to conduct a comprehensive review on the role of botulinum toxin A (BonTA) in the treatment of pelvic floor dysfunctions in the elderly. METHODS The present article, written as a comprehensive review of the literature, combines data issued from the scientific literature with expert's opinions. Review of the literature was performed using the online bibliographic database MedLine (National Library of Medicine). Regarding intra-detrusor BonTA injections, only articles focusing on elderly patients (>65 yo) were included. Regarding other localizations, given the limited number of data, all articles reporting outcomes of BonTA were included, regardless of studies population age. In case of missing or insufficient data, expert's opinions were formulated. RESULTS Although, available data are lacking in this specific population, it appears that BonTA could be used in the non-fraily elderly patients to treat overactive bladder or even neurogenic detrusor overactivity, with a success rate comparable to younger population at 3 months (88.9% vs. 91.2%), 6 months (49.4% vs. 52.1%) and 12 months (23.1% vs. 22.3%), as well as a significant decrease in number of voids per day (11.4 vs. 5.29 P<0.001) and in the number of pads per day (4.0 vs. 1.3, P<0.01). Furthermore, BonTA is likely to be offered in the future as a treatment of fecal incontinence and obstructed defecation syndrome symptoms. Concerning bladder outlet obstruction/voiding dysfunction symptoms, intra-urethral sphincter BonTA should not be recommended. CONCLUSION BonTA injections are of interest in the management of various pelvic floor dysfunctions in the elderly, and its various applications should be better evaluated in this specific population in order to further determine its safety and efficacy.
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Richard C, Peyronnet B, Bendavid C, Hascoet J, Alimi Q, Khene Z, Kerdraon J, Manunta A, Gamé X. Physiopathologie de l’hyperactivité détrusorienne neurogène : rôle relatif des neurotrophines, de l’inflammation et de la matrice extracellulaire en fonction de la pathologie neurologique. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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El Akri M, Brochard C, Hascoet J, Jezequel M, Alimi Q, Khene ZE, Richard C, Bonan I, Kerdraon J, Gamé X, Manunta A, Siproudhis L, Peyronnet B. Risk of prolapse and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor using clean intermittent catheterization versus Valsalva voiding. Neurourol Urodyn 2018; 38:269-277. [PMID: 30311685 DOI: 10.1002/nau.23844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/15/2018] [Indexed: 01/15/2023]
Abstract
AIMS To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC). METHODS We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. RESULTS Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). CONCLUSIONS Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups.
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Peyronnet B, Brochard C, Jezequel M, Hascoet J, Alimi Q, Senal N, Carsin-Nicole B, Riffaud L, Le Reste PJ, Bonan I, Olivari-Philiponnet C, Siproudhis L, Kerdraon J, Game X, Manunta A. Comparison of neurogenic lower urinary tract dysfunctions in open versus closed spinal dysraphism: A prospective cross-sectional study of 318 patients. Neurourol Urodyn 2018; 37:2818-2826. [DOI: 10.1002/nau.23782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
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Chesnel C, Charlanes A, Declemy A, Le Breton F, Kerdraon J, Sheikh Ismael S, Amarenco G. Emptying cystometry: A feasibility and validation pilot study on female patients. Prog Urol 2018; 28:542-547. [PMID: 30017704 DOI: 10.1016/j.purol.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/25/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To assess the feasibility and the accuracy of emptying cystometry in order to simplify the manometric follow-up of overactive detrusor in neurological patients under anticholinergic or botulinum toxin injections. MATERIAL Female patients with a stable detrusor underwent both a conventional cystometry and sequential measurements of bladder pressure during emptying (emptying cystometry). At the end of the standard cystometry, a CH12 urinary catheter was introduced in the bladder and was connected to a three-way stopcock. The second way of the stopcock permitted the emptying. The third way of the stopcock was connected to a vertical graduated tube to measure the bladder pressure each 50mL during the bladder emptying. RESULTS Eleven female patients were included (mean age: 59.4years). Nine patients (82%) had neurogenic bladder. Mean cystometric capacity was 439mL (SD: 35mL). During the emptying cystometry, 8 to 10 measures were taken (mean: 9.4). The mean detrusor pressure was 1.7cmH2O (SD 2.1) for the filling cystometry and 2.3cmH2O (SD: 2.7) for the emptying cystometry. The agreement between the detrusor pressure between the two cystometries was good with intra-class correlation coefficient at 0.66 [0.48-0.77] - and the correlation was high (r=0.7; P<0.000001). CONCLUSION In a small, selected sample of patients, emptying cystometry provides similar results of detrusor pressure to filling cystometry. This technique could constitute a home monitoring of bladder pressures in a selected population of patients with intermittent catheterization in whom a manometric follow-up of detrusor overactivity is required. LEVEL OF EVIDENCE 4.
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Peyronnet B, Gao F, Brochard C, Oger E, Scailteux L, Alimi Q, Khene Z, Jezequel M, Olivari-Philiponnet C, Ménard H, Kerdraon J, Senal N, Gamé X, Siproudhis L, Manunta A. Urological disorders are still the leading cause of death in patients with spinal dysraphism. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Olivari-Philiponnet C, Manunta, Brochard C, Jezequel M, Menard H, Hascoet J, Senal N, Bonan I, Siproudhis L, Kerdraon J, Game X, Peyronnet B. Comparison of neurogenic lower urinary tract dysfunctions in open vs. closed spinal dysraphism: Results observed in a prospective cohort of 395 patients. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rémy-Néris O, Médée B, Bensmail D, Daveluy W, Benaim C, Froger J, Bonan I, Marque P, Luaute J, Ferrapie A, Yelnik A, Stefan A, Daviet J, Coudeyre E, Beis J, Kerdraon J, Isambert J, Dehail P. Rehabilitation robotics of the upper limb after stroke. The REM_AVC trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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KHENE ZE, Paret F, PERROUIN-VERBE MA, PRUDHOMME T, Hascoet J, Nedelec M, Kerdraon J, Menard H, Jezequel M, Le normand L, Manunta A, Gamé X, Peyronnet B. PD39-01 ARTIFICIAL URINARY SPHINCTER IN MALE PATIENTS WITH SPINA BIFIDA: COMPARISON OF PERIOPERATIVE AND FUNCTIONAL OUTCOMES BETWEEN BULBAR URETHRA AND BLADDER NECK CUFF PLACEMENT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Gambachidze D, Lefévre C, Perrouin-Verbe M, Chartier-Kastler E, Kerdraon J, Egon G, Even A, Castel-Lacanal E, Gamé X, Ruffion A, verde KL, Karsenty G, Phé V. Escarres sacrées et fistules urétro-périnéales des patients blessés médullaires : évaluation du devenir fonctionnel et urologique au sein d’équipes multidisciplinaires. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khene Z, Paret F, Nedelec M, Prudhomme T, Hascoet J, Kerdraon J, Menard H, Jezequel M, Perrouin-Verbe M, Le Normand L, Gamé X, Saussine C, Chartier-Kastler E, Manunta A, Peyronnet B. Sphincter artificiel urinaire chez les patients spina bifida de sexe masculin : comparaison de deux sites d’implantation de la manchette périprostatique et péri-bulbaire. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hascoet J, Gao F, Brochard C, Oger E, Kerdraon J, Senal N, Gamé X, Spiroudhis L, Manunta A, Peyronnet B. Les pathologies urologiques restent la première cause de décès chez les patients spina bifida. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Khene Z, Manunta A, Hascoet J, Brochard C, Kerdraon J, Menard H, Senal N, Jezequel M, Bonan I, Spiroudhis L, Odent S, Journel H, Gamé X, Peyronnet B. Résultats à long terme du sphincter urinaire artificiel chez les patients spina bifida de sexe masculin. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Peyronnet B, Vincendeau S, Freton L, Tondut L, Alimi Q, Khene Z, Pradere B, Bensalah K, Senal N, Kerdraon J, Hascoet J, Manunta A. Implantation de sphincter urinaire artificiel pour incontinence urinaire d’effort chez la femme : comparaison des voies ouverte, cœlioscopique et robot-assistée. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alimi Q, Hascoet J, Manunta A, Kammerer-Jacquet SF, Verhoest G, Brochard C, Freton L, Kerdraon J, Senal N, Siproudhis L, Rioux-Leclercq N, Brucker B, Gamé X, Peyronnet B. Reliability of urinary cytology and cystoscopy for the screening and diagnosis of bladder cancer in patients with neurogenic bladder: A systematic review. Neurourol Urodyn 2017; 37:916-925. [DOI: 10.1002/nau.23395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/05/2017] [Indexed: 11/07/2022]
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Kerdraon J, Peyronnet B, Gamé X, Fatton B, Haddad R, Hentzen C, Jeandel C, Mares P, Mezzadri M, Petit AC, Robain G, Vetel JM, Amarenco G. Physiopathologie de l’hypoactivité détrusorienne de la personne âgée. Prog Urol 2017; 27:402-412. [DOI: 10.1016/j.purol.2017.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/13/2017] [Indexed: 01/21/2023]
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Bottet F, Peyronnet B, Boissier R, Reiss B, Previnaire JG, Manunta A, Kerdraon J, Ruffion A, Lenormand L, Perrouin Verbe B, Gaillet S, Gamé X, Karsenty G. Switch to Abobotulinum toxin A may be useful in the treatment of neurogenic detrusor overactivity when intradetrusor injections of Onabotulinum toxin A failed. Neurourol Urodyn 2017; 37:291-297. [PMID: 28431196 DOI: 10.1002/nau.23291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/27/2017] [Indexed: 11/08/2022]
Abstract
AIMS To assess the outcomes of switching to a different brand of botulinum toxin A (BTA, from Botox® to Dysport®) in case of failure of intradetrusor injections (IDI) of Botox® in the treatment of neurogenic detrusor overactivity (NDO). METHODS The charts of all patients who underwent a switch to IDI of Dysport® after failure of an IDI of Botox® at six departments of neurourology were retrospectively reviewed. The main outcomes of interest were the bladder diary data and four urodynamic parameters: maximum cystometric capacity (MCC), maximum detrusor pressure (PDET max), and volume at first uninhibited detrusor contraction (UDC). RESULTS Fifty-seven patients were included. After the first injection of Dysport®, no adverse events were reported. A significant decrease in number of urinary incontinence episodes per day was observed in 52.63% of patients (P < 0.001) and all patients experienced a reduction in PDET Max (-8.1 cmH20 on average; P = 0.003). MCC significantly increased by a mean of 41.2 (P = 0.02). The proportion of patients with no UDC increased significantly at week 6 after ATA injections (from 15.79% to 43.9%; P = 0.0002). Hence, 32 patients draw clinical and/or urodynamic benefits from the botulinum toxin switch from (56.14%). After a median follow up of 21 months, 87% of responders to BTA switch were still treated successfully with BTA. CONCLUSION Most patients refractory to Botox® (56.14%) draw benefits from the switch to Dysport®.
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Guinet-Lacoste A, Kerdraon J, Rousseau A, Gallien P, Previnaire JG, Perrouin-Verbe B, Amarenco G. Intermittent catheterization acceptance test (I-CAT): A tool to evaluate the global acceptance to practice clean intermittent self-catheterization. Neurourol Urodyn 2017; 36:1846-1854. [DOI: 10.1002/nau.23195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 11/25/2016] [Indexed: 11/09/2022]
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Tondut L, Enderlé I, Alimi Q, Freton L, Gires B, Senal N, Bonan I, Bensalah K, Kerdraon J, Manunta A, Peyronnet B. Résultats des ballonnets ACT® chez les femmes âgées de plus de 80ans et sur terrain radique. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peyronnet B, Vincendeau S, Grison P, Alimi Q, Freton L, Tondut L, Gires B, Bensalah K, Senal N, Bonan I, Kerdraon J, Manunta A. Implantation robot-assistée péricervicale du sphincter artificiel urinaire AMS 800 pour incontinence urinaire par insuffisance sphinctérienne neurogène chez l’homme. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peyronnet B, Gao F, Brochard C, Oger E, Menard H, Arnaud A, Hascoet J, Kerdraon J, Siproudhis L, Game X, Manunta A. Épidémiologie du spina bifida en France. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peyronnet B, Amarenco G, De seze M, Schurch B, Even A, Capon G, Baron M, Hascoet J, Castel-lacanal E, Lenormand C, Biardeau X, Maurin C, Monleon L, Marcelli F, Perrouin-verbe M, Allenet C, Cornu J, Mouracade P, Boutin J, Saussine C, Grise P, Lenormand L, Kerdraon J, Chartier-kastler E, Karsenty G, Denys P, Manunta A, Gamé X. Peut-on éviter l’entérocystoplastie d’agrandissement en cas d’échec d’une première injection intra-détrusorienne de toxine botulique chez un patient spina bifida ? Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hascoet J, Manunta A, Brochard C, Arnaud A, Damphousse M, Menard H, Kerdraon J, Journel H, Bonan I, Odent S, Fremond B, Siproudhis L, Gamé X, Peyronnet B. Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review. Neurourol Urodyn 2016; 36:557-564. [PMID: 27187872 DOI: 10.1002/nau.23025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. OBJECTIVE To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. METHODS A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. RESULT Twelve published series were included (n = 293 patients). All patients were <18 years old. There was no randomized study comparing BTX-A versus placebo and most studies had no control group. Most studies reported a clinical and urodynamic improvement with resolution of incontinence in 32-100% of patients, a decrease in maximum detrusor pressure from 32 to 54%, an increase of maximum cystometric capacity from 27 to 162%, and an improvement in bladder compliance of 28-176%. Two studies suggested lower efficacy in patients with low compliance bladder compared to those with isolated detrusor overactivity. CONCLUSION Intradetrusor injections of BTX-A could be effective in children with spina bifida but this assumption is not supported by high level of evidence studies. There is no data available in adult patients. Neurourol. Urodynam. 36:557-564, 2017. © 2016 Wiley Periodicals, Inc.
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Peyronnet B, Sanson S, Amarenco G, Castel-Lacanal E, Chartier-Kastler E, Charvier K, Damphousse M, Denys P, de Seze M, Egon G, Even A, Forin V, Karsenty G, Kerdraon J, le Normand L, Loche CM, Manunta A, Mouracade P, Phe V, Previnaire JG, Ruffion A, Saussine C, Schurch B, Game X. Définition et prise en charge de l’échec d’une première injection de toxine botulique Botox® 200 U pour hyperactivité détrusorienne neurogène : résultats de l’enquête DETOX. Prog Urol 2015; 25:1219-24. [DOI: 10.1016/j.purol.2015.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022]
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Zanollo LG, Stensrød GC, Kerdraon J, Lund KG, Halvorsen A, Losavio E, Als KS, Soler JM. Standardized intermittent catheterisation education improves catheterisation compliance in individuals with spinal cord injury. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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