A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics.

BACKGROUND: We have observed different clinical responses to botulinum toxin A (BTX-A) in patients who had similar urodynamic parameters before the procedure. Furthermore, some bladders evaluated by cystography and cystoscopy during the procedure had different characteristics that could influence the outcome of the treatment. The aim of this study was to assess whether cystography and urodynamic parameters could help predict which patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergics respond better to treatment with injection of BTX-A. METHODS: In total, 34 patients with spinal cord injury were prospectively evaluated. All patients emptied their bladder by clean intermittent catheterization (CIC) and had incontinence and NDO, despite using 40 mg or more of intravesical oxybutynin and undergoing detrusor injection of BTX-A (300 IU). Pretreatment evaluation included urodynamic, and cystography. Follow-up consisted of urodynamic and ambulatory visits four months after treatment. The cystography parameters used were bladder shape, capacity and presence of diverticula. Urodynamic parameters used for assessment were maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), compliance and reflex volume (RV). RESULTS: After injection of BTX-A, 70% of the patients had success, with 4 months or more of continence. Before the treatment, there were significant differences in most urodynamic parameters between those who responded successfully compared to those who did not. Patients who responded successfully had greater MCC (p = 0.019), higher RV (p = 0.041), and greater compliance (p = 0.043). There was no significant difference in the MDP (0.691). The cystography parameters were not significantly different between these groups bladder shape (p = 0.271), capacity (p > 0.720) and presence of diverticula (p > 0.999). Statistical analyses were performed using SPSS (version 20.0) and included Student's t-test for two paired samples and Fisher's exact test, with a significance threshold of 0.05. CONCLUSIONS: This study suggests that the cystography parameters evaluated cannot be used to help predict the response to injection of BTX-A in the treatment of refractory NDO. However, the urodynamic parameters were significantly different in patients who responded to the treatment, with the exception of the MDP.

Lower urinary tract dysfunction in children with cerebral palsy.

AIMS: The focus of this study was to evaluate urodynamic findings and possible renal damage in children with cerebral palsy and urinary symptoms. METHODS: Children with cerebral palsy and lower urinary tract symptoms were studied. Patients were submitted to urodynamic evaluation, urine examination, measurement of serum creatinine, and renal and urinary tract ultrasonography. Voiding cystourethrography was performed on patients with urinary tract infections. RESULTS: Thirty-seven children were investigated, including 21 females and 16 males. The mean age was 7 years and 8 months [SD of 4 years 6 months], with a range from 1 to 17-year-old. The symptoms that led to evaluation were urinary infections in 21 56.7% cases, incontinence in 15 (40.5%) cases, increased voiding frequency in six (16%) cases, enuresis in five (13.5%) cases, and hesitancy and urgency in two (5.4%) cases each. The urodynamic findings involved reduced bladder capacity in 20 (54%) cases, with mean cystometric capacity of 168.0 +/- 122.2 ml. Detrusor overactivity was observed in 13 (35.1%) cases, with mean of 67.9 +/- 34.6 cmH(2)O. The range of the residual volume was 17.5 +/- 33.5 ml, which was increased in five (13.5%) cases. Low bladder compliance was seen in four (10.8%) patients, mean bladder compliance of 22.2 +/- 12.2 ml/cmH(2)O. No hydronephrosis or reflux was observed. CONCLUSION: Almost one-third of the patients with cerebral palsy and urinary symptoms presented with normal urodynamic findings. The most frequent findings were reduced bladder capacity, detrusor overactivity, and increased post-void residual. No urinary tract complications were observed.