Botulinum A Toxin Urethral Sphincter Injection in Children With Nonneurogenic Neurogenic Bladder

PURPOSE

We evaluated botulinum-A toxin (Botox) injection into the urethral urinary sphincter in children with nonneurogenic neurogenic bladder to decrease urethral resistance and improve voiding. In these patients alpha-blocker medications had failed and injection was an alternative to unavailable biofeedback.

MATERIALS AND METHODS

Prospective treatment was performed in 10 children 6 to 17 years old (mean age 8) with nonneurogenic neurogenic bladder using botulinum-A toxin (Botox). Preoperatively all children were evaluated by ultrasound, voiding cystourethrography, excretory urography, magnetic resonance imaging and urodynamic studies, including pressure flow, electromyography and uroflowmetry. One patient had unilateral G3 reflux and 4 had bilateral G1 to G3 hydronephrosis. Using a rigid pediatric endoscope and a 4Fr injection needle 50 to 100 IU botulinum-A toxin were injected into the external sphincter at the 3, 6 and 9 o'clock positions. Followup was 6 to 15 months. Repeat injections every month were given according to the response with a maximum of 3 injections.

RESULTS

Immediately after botulinum-A toxin injection all except 1 patient were able to void without catheterization. No acute complications occurred. Four patients with bilateral hydronephrosis and the patient with the refluxing unit showed regression. Postoperatively post-void residual urine decreased by 89%, detrusor leak point pressure decreased significantly by a mean +/- SD of 66 +/- 18 vs 37 +/- 4 cm H(2)O and uroflowmetry showed a marked increase in maximum urine flow of 2 +/- 2 vs 17.8 +/- 8 ml per second. Three injections were needed in 1 patient to attain the desired response.

CONCLUSIONS

Urethral sphincter botulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.

The Use of 4-(3,4-Dichlorophenyl)-4-Oxo-2-(4-Antipyrinyl)-Butanoic Acid in the Preparation of Some New Heterocyclic Compounds With Expected Biological Activity

Reaction of 4-oxo-4-(3,4-dichlorophenyl)-2-butenoic acid (1) with antipyrin (2) gave the corresponding butanoic acid 3. Reaction of 3 with hydrazines gave the pyridazinone derivatives 5a,b. Compounds 5a,b were used to prepare the corresponding dithio derivatives. Reaction of 5a with POCl₃ unexpectedly gave the chloropyridazine derivative 7, which is used to prepare the corresponding thio derivative. The hitherto unknown reactions of this chloro derivative with 2-amino-3-carbethoxy-4,5-dimethylthiophene and 2-amino-3-carbethoxy tetrahydrobenzothiophene have now been described. The behaviour of the chloro derivative toward hydrazine hydrate, sodium azide and anthranilic acid was also studied. Some of the new compounds showed antimicrobial and antifungal activities.

Studying the etiology of deafness in the "deaf" schools of Alexandria

Two hundred and twenty three children with childhood deafness were included in this study. They were collected randomly from pupils of Al-Amal schools for the deaf in Alexandria. They were subjected to complete audiological examinations. One hundred and three cases had genetically determined deafness, 12 cases were due to prenatal causes, 20 cases to perinatal causes, 45 cases to postnatal causes, and 43 cases with undefined etiology. One hundred and ninety cases had prelingual deafness, 25 cases had perilingual deafness, and only 8 cases had postlingual deafness. Consanguinity with positive family history for deafness was found to be the most important factor in the genetically determined deafness. Rubella was the most important prenatal cause, while perinatal hypoxia was the most important perinatal cause, and meningitis was the most important postnatal cause. The results were compared with another study that was conducted 25 years ago in the same schools. The comparison was done in view of the changes that occurred in the Egyptian society in the last quarter of a century.

Geographic information systems and the distribution of Schistosoma mansoni in the Nile delta

New computer-based sensor technology and geographic methods have led to emerging interest in use of satellite environmental assessment tools for design of disease control programs, especially for those that are vector borne. The long-range goal of work reported here by John Malone and colleagues on behalf of this Egyptian Ministry of Health-USAID Schistosomiasis Research Project team (Box 1) is to utilize data from sensor systems on board earth-observing satellites to develop more-sensitive disease-prediction and -control models. If successful, methods developed may provide a potentially vital capability for use by disease control program managers, particularly in less-developed countries, where mapping resources are not well advanced. Longer term, broader basic questions on the interaction of environment and disease in anticipation of predicted global climate change may be addressed. These studies focused on the lower Nile river basin of Egypt. The specific objective was to link data on environmental requirements for propagation and transmission of schistosomiasis with parameters measurable from space.