Objective and subjective improvement in children with idiopathic detrusor overactivity after intravesical botulinum toxin injection: A preliminary report.

OBJECTIVE: The purpose of this study is to evaluate the effect of Intravesical Botulinum toxin injection on the symptoms and urodynamic parameters in pediatric patients with idiopathic overactive bladder (iOAB) refractory to medical treatment. MATERIALS AND METHODS: The study was designed as an open-label uncontrolled therapeutic clinical trial. The eligible patients who underwent Intravesical botulinum toxin injection were evaluated before treatment. The evaluation included a 7-day paper bladder diary to assess OAB symptoms (frequency, urgency urinary incontinence (UUI) and nocturnal enuresis (NE)), filling the Arabic International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI short form), and conducting urodynamic study. The Urodynamic parameters obtained were the maximum filling detrusor pressure, cystometric bladder capacity, and compliance. After 12 weeks of the intravesical injection, the patients were revaluated and the results were compared using paired samples t-test. RESULTS: The study enrolled 75 patients. And of those, statistical analysis was done on 46 patients who did follow the study protocols. The mean age was 8.9 years and male to female ratio was 1:4. There was a statistically significant improvement in overactive bladder symptoms and urodynamic parameters in the patient injected with botulinum toxin with minimal side effects. CONCLUSION: The evidence in this study would support the safety and efficacy of Intravesical botulinum toxin injection in children with refractory idiopathic OAB with significant improvement of symptoms, quality of life, as well as urodynamic parameters. TYPE OF STUDY: Open-label uncontrolled therapeutic clinical trial. LEVEL OF EVIDENCE: III.

Squamous cell carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture: A case report.

INTRODUCTION: Spontaneous intraperitoneal bladder rupture can present with symptoms of acute abdomen. The associated high mortality rate is attributed to the delay in diagnosis, and the possibility of the presence of a bladder carcinoma contributes to high mortality as well. CASE PRESENTATION: We present a case of spontaneous intraperitoneal bladder rupture associated with squamous cell carcinoma managed with partial cystectomy. DISCUSSION: The incidence of this condition is (1:126,000) but with high mortality rate. It occurs more commonly in male [1]. It can be associated with carcinoma, chronic cystitis, chronic catheterization, bladder outflow obstruction and others. Standard management includes timely diagnosis of this condition, followed by bladder repair in the form of primary closure, partial cystectomy or radical cystectomy. However in the presence of carcinoma the prognosis is poor. CONCLUSION: high index of clinical suspicion and the timely diagnosis can lead to a more favorable outcome.