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tion, and some suffer side effects from anticholinergic drugs, even if administrated intra-vesically.

Indications

Persisting leak-point-pressure over 40 cm H2O after oral anticholinergic medication oxybuty-nin chloride (Ditropan) 0.3 mg/ kg body weight twice a day or tolterodine chloride (Detrusitol) 0.1 mg/kg bw twice a day or subsequent intravesical administration of oxybutynin (Systral) 0.3 mg/kg bw daily with increasing dosages of up to 0.9 mg/kg bw daily.

Technique

— Fill the bladder to the half of the age-related capacity.

— delute 100 U of toxin in 10 cc of normal saline.

— Use the 3.7-Fr 25-cm-long polytetrafluoro-ethylene-coated injection needle (Wiliams needle, Cook Urological).

— Inject 10 U botulinum-A toxin (BTX-A) cystoscopically into the detrusor at each of the 25-30 sites all over the bladder, randomly.

Tips and Tricks

— Prepare the solution and calculate the dosage (dosage ranges from 10 U/kg to a maximum of 360 U) before starting the procedure.

— Avoid injecting the solution intraperitone-ally.

— Empty the bladder after the endoscopic treatment and start clean intermittent cathe-terism (CIC) again on the same day.

— Stop anticholinergic treatment after injection therapy.

Maximum detrusor pressure decreases, maximum bladder capacity and detrusor compliance increase and the incontinence score improves. Many children are dry between the CIC intervals. Preliminary results report a therapeutic effect that lasts proximately 9-12 months.

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