826 BOTULINUM-A TOXIN – AN ALTERNATIVE FOR INCONTINENT CHILDREN WITH THERAPY RESISTANT OVERACTIVE BLADDER?

Vol. 185, No. 4S, Supplement, Monday, May 16, 2011

826 BOTULINUM-A TOXIN – AN ALTERNATIVE FOR INCONTINENT CHILDREN WITH THERAPY RESISTANT OVERACTIVE BLADDER? Achim Lusch*, Patrick Krombach, Felix Wezel, Maurice Stephan Michel, Mannheim, Germany INTRODUCTION AND OBJECTIVES: Botulinum-A toxin is a well established medikation for neurogenic detrusor overactivity. Recent studies showed good short time results in therapy of ideopathic detrusor overactivity in adults. This prospective study included therapy resistant children with overactive bladder. METHODS: 17 children (6 boys and 11 girls) with resistant non neurogenic detrusor overactivity, decreased capacity bladder for age and urge were included. All patients showed a urge incontinence as well as a enuresis. Main treatment duration before botox injection was 39 month. A dose of 100 U of botulinum-A toxin was injected in the detrusor muscle. RESULTS: 12 patients (8 girls und 4 boys) showed full reponse after 1 injection (dry over the day and complete loss of urge) with a mean increase in bladder capacity from 147 to 233 ml. 3 girls and 1 boy showed a partial response – 60% decrease in incontinence over the day and urge, increase of bladder capacity from 162 ml to 251 ml (p⬍0,001). One boy remained unchanged. 11 of the 12 full responders were still cured after 12 month, while 1 boy showed relapse after 7 month. The 3 girls with partial response and 1 boy with relapse underwent 2nd injection with full response of the former full responder and in 2 of the former partial responders. 2 girls remained unchanged. Side effects were reported in 3 children mit temporaryly increased residual bladder volume up to 2 weeks after injection, 1 girl experienced 1 episode of symptomatic lower urinary tract infection. CONCLUSIONS: Botulinum-A toxin injection in children with non-neurogenic overactive detrusor is an excellent treatment adjunct with marginal side effects and good long time results after 1 injection of 71%, after 2nd injection of 88%. Source of Funding: None

827 ENURETIC CHILDREN WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS): SHOULD THEY SEE OTOLARYNGOLOGY FIRST? Larisa Kovacevic, Detroit, MI; Ali Dabaja*, Michael Jurewicz, Detriot, MI; Brittany Renolds, Detroit, MI; Amy Rutt, David Madgi, Yegappan Lakshmanan, Detriot, MI INTRODUCTION AND OBJECTIVES: (1)To Investigate the effect of tonsillectomy and adenoidectomy(T&A)on enuresis in children with OSAS, and (2) to identify factors that may predict lack of response of enuresis. METHODS: Children 5–18 years of age with OSAS and nocturnal enuresis (NE) who underwent T&A between September 2008 and September 2010 were included. Study consisted of a phone interview and chart review. Severity of nocturnal and diurnal enuresis (DE), frequency, arousal and sleeping disturbances were assessed pre and post T&A. Student’s t test and Fisher’s exact test were used for data analysis. Pre and post-surgery differences between groups were examined by parametric analysis of covariance (ANCOVA). A binary logistic regression model was used to identify the best predictive factor of non-response. RESULTS: Among the 417 children who underwent T&A 101 (24%) had NE, and of those 23 had DE. The mean postoperative follow-up was 11.7 months. Of the 49 responders 30 showed resolution of their NE in less then 1 month post-operatively. DE resolved in 4 children, improved in 4, and did not change in 15 children post T&A.

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CONCLUSIONS: T&A led to resolution of NE in about 50% of children with OSAS. Lower response rate was associated with male gender, prematurity, obesity, non MNE, and family history of NE. Prematurity was the single best predictor of failure to respond to T&A. Improved arousal may be partly responsible for the effect of T&A on both NE and DE in children with OSAS.

Source of Funding: None

828 SURGICAL RELEASE OF SECONDARY SPINAL CORD TETHERING IMPROVES THE PROGNOSIS OF NEUROGENIC BLADDER IN CHILDREN WITH MYELOMENINGOCELE – AN UPDATE Tufan Tarcan, Ilker Tinay*, Cagri Akin Sekerci, Fatih Fikret Onol, Ferruh Simsek, Memet Ozek, Istanbul, Turkey INTRODUCTION AND OBJECTIVES: Urological, neurological or orthopedic deterioration during follow-up are strong indicators for the diagnosis of secondary tethering of the spinal cord in children with prior closure of an open spinal defect. The outcome of untethering surgery cannot always be predicted. We have previously showed that secondary untethering surgery may significantly improve urological outcome. Herein, we up-dated our results with our growing experience. METHODS: Of 745 children with myelomeningocele followed at our multidisciplinary spina bifida clinic between 1996 and 2009, 71 (9.5 %) were diagnosed with secondary tethering of the spinal cord (median age at diagnosis 4.6 years). The diagnosis was based on urological and neuro-orthopedic deterioration in 56 % and 44 % of children, respectively. Preoperative urological findings were compared with 6-month postoperative findings. RESULTS: Febrile urinary tract infection, upper tract dilatation and vesicoureteral reflux were preoperatively documented in 56.3 %, 18.3 % and 26.7 % of the 71 children, respectively. At 6 months postoperatively urine cultures were sterile in 46.8 % of patients and upper tract dilatation completely resolved in 56.3 %. For all grades of vesicoureteral reflux, complete resolution occurred in 57.7 % of patients. Urodynamic parameters in terms of cystometric bladder capacity and detrusor leak point pressure substantially improved 6 months after untethering surgery (121.6 vs 172.4 ml and 64.8 vs 44.6 cm H2O, respectively, p⬍ 0.05). CONCLUSIONS: Secondary tethering of the spinal cord is a major risk factor for urological and neurological deterioration in children with myelomeningocele and close urological surveillance remains the most valuable tool in the early diagnosis. Our study shows that secondary untethering surgery may significantly improve urological outcome. Source of Funding: None