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POS-02.120: Status quo of repeated botulinum-toxin injections in spina bifida children with detrusor hyperreflexia: long term follow up
UNMODERATED POSTER SESSIONS
examination.Twe observers using a Takihara orchiometer measured the volume of the contralateral testis. Results: A total of 25 patients had contralateral hypertophy greater than 2 ml. including 19 (76%) with vanishing testis and 4 (16%) with an intra-canal testis and 2 (8%) with an intra-abdominal testis. Of the 7 patients with a contralateral measurement 1.5ml to 2.0 ml. Give (71.4%) had vanishing testis and 2 (28.6%) had an intra-canal testis.Of the 15 patients with a contralateral measurement of less than 1.5 ml .11 (73.3%) had a testis ,which was intra-abdominal in 3 and canalicular in 8. Conclusions: Our data confirm that in boys with a unilateral nonpalpable testis contralateral testis hypertrophy is a strong indicator of monorchia.Hypertrophy 1.5 ml. or greater predict monorchia with an accuracy of about 75%. Abstract Withdrawn POS-02.119 Intravesical oxybutynin for children with poorly compliant neurogenic bladders: a Systematic Review Guerra LA1, Moher D2, Barrowman N2, Sampson M2, Pike J1, Leonard M1 1 University of Ottawa - Children’s Hospital of Eastern Ontario, Ottawa, ON; 2 CHEO Research Institute, Ottawa, ON Introduction: Children with neurogenic bladders and poor bladder compliance are usually managed with bladder catheterization and oral anticholinergic medication. They may become nonresponders to the drug or present with severe harms. Objective: To evaluate the effectiveness and tolerability of intravesical oxybutynin in children with poorly compliant neurogenic bladders. Methods: Pubmed, Embase, Cinahl, SciELO, Disertations/thesis in Proquest, Li-
lacs, Cochrane databases, protocol registries and grey literature were searched systematically. Two reviewers independently assessed study quality and extracted data. Results: Eight studies (2 prospective; 6 retrospective), assessed the effectiveness and harms of intravesical oxybutynin in children with neurogenic bladders. Reports were generally of poor quality, with weak study designs (single group beforeafter evaluations). In total, 297 children started treatment and 22.2% (66/297) discontinued the therapy; 9.4% (28/297) quit due to systemic harms. Mean change in bladder compliance (primary outcome) was reported in only 2 studies (⫹7.4 and ⫹7.5 ml/cmH2O). The pooled mean change in pressure at total bladder capacity (TBC) was -16.4 cmH2O (95% CI: -22.77 to –10.02). TBC was not pooled (I2⫽61%; forest plot suggested high inconsistency). Incontinence improved significantly in most studies, with “dry and improved” from 61 to 83 %. The funnel plot of pressure at TBC suggested no publication bias. Conclusion: Adjunctive intravesical oxybutynin therapy increased the mean total bladder capacity and decreased bladder pressure in children with neurogenic bladders. However, identified studies offered a low level of evidence; most were poorly reported retrospective case series with potential biases. Although the incidence of harm was lower with the intravesical route, they are still possible and should be discussed with patients and families. The evidence in this review is insufficient to recommend this therapy. Research of more sound study design such as a RCT should be conducted to assess the efficacy and harms of intravesical oxybutynin in children.
Table 1. POS-02.119
UROLOGY 70 (Supplment 3A), September 2007
POS-02.120 Status quo of repeated botulinumtoxin injections in spina bifida children with detrusor hyperreflexia: long term follow up Laschke S, Carl S 1 NUKS Neurourological Center, Emmendingen, Germany Introduction: The efficiency of botulinum toxin A in children with spina bifida and detrusor hyperreflexia is proven in several studies. But what happens to children with repeated injections over five years? Methods: Basic studies were standardised urodynamic examination according to ICS criteria. CIC was instituted as initial treatment. Low compliance situation was determined, renal function was evaluated by serum creatinin levels and MAG-3 renal scans. A questionnaire of life score was established. Injections were repeated after six month. Results: In nearly all cases (19/20) good results were found with complete suppression of the hyperreflexic detrusor activity. Conclusions: Botulinum-toxin A (Dysport R) injection in detrusor hyperreflexia mmc-children is a good accepted, very effective and potent therapeutic option also for repeated injections over years to prevent children from bladder augmentation or urinary diversion. POS-02.121 Results of continent vesicostomy as a newer alternative to appendicovesicostomy for Mitrofanoff procedure Irani D Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Introduction: We present our experience using continent vesicostomy as a Mitrofanoff technique to creat a continent catheterizable stoma as an adjunct to continent urinary tract reconstruction in children and young adults. Methods: Between Sept. 2000 and March 2006, a total of 15 patients (8 male, 7 female) 4 to 20 years old (mean age 9) underwent the Mitrofanoff procedure using a modification of the Cain and Casale vesicostomy. The technique of continent vesicostomy involved a 2 to 3 cm extravesical detrusor muscle and mucosal tube and a 3 cm. intravesical mucosal tube within a submucosal tunnel to provide the continence mechanism. The diagnoses were neurogenic bladder in 11 cases, bladder exstrophy in 2, valve bladder in 1 case
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examination.Twe observers using a Takihara orchiometer measured the volume of the contralateral testis. Results: A total of 25 patients had contralateral hypertophy greater than 2 ml. including 19 (76%) with vanishing testis and 4 (16%) with an intra-canal testis and 2 (8%) with an intra-abdominal testis. Of the 7 patients with a contralateral measurement 1.5ml to 2.0 ml. Give (71.4%) had vanishing testis and 2 (28.6%) had an intra-canal testis.Of the 15 patients with a contralateral measurement of less than 1.5 ml .11 (73.3%) had a testis ,which was intra-abdominal in 3 and canalicular in 8. Conclusions: Our data confirm that in boys with a unilateral nonpalpable testis contralateral testis hypertrophy is a strong indicator of monorchia.Hypertrophy 1.5 ml. or greater predict monorchia with an accuracy of about 75%. Abstract Withdrawn POS-02.119 Intravesical oxybutynin for children with poorly compliant neurogenic bladders: a Systematic Review Guerra LA1, Moher D2, Barrowman N2, Sampson M2, Pike J1, Leonard M1 1 University of Ottawa - Children’s Hospital of Eastern Ontario, Ottawa, ON; 2 CHEO Research Institute, Ottawa, ON Introduction: Children with neurogenic bladders and poor bladder compliance are usually managed with bladder catheterization and oral anticholinergic medication. They may become nonresponders to the drug or present with severe harms. Objective: To evaluate the effectiveness and tolerability of intravesical oxybutynin in children with poorly compliant neurogenic bladders. Methods: Pubmed, Embase, Cinahl, SciELO, Disertations/thesis in Proquest, Li-
lacs, Cochrane databases, protocol registries and grey literature were searched systematically. Two reviewers independently assessed study quality and extracted data. Results: Eight studies (2 prospective; 6 retrospective), assessed the effectiveness and harms of intravesical oxybutynin in children with neurogenic bladders. Reports were generally of poor quality, with weak study designs (single group beforeafter evaluations). In total, 297 children started treatment and 22.2% (66/297) discontinued the therapy; 9.4% (28/297) quit due to systemic harms. Mean change in bladder compliance (primary outcome) was reported in only 2 studies (⫹7.4 and ⫹7.5 ml/cmH2O). The pooled mean change in pressure at total bladder capacity (TBC) was -16.4 cmH2O (95% CI: -22.77 to –10.02). TBC was not pooled (I2⫽61%; forest plot suggested high inconsistency). Incontinence improved significantly in most studies, with “dry and improved” from 61 to 83 %. The funnel plot of pressure at TBC suggested no publication bias. Conclusion: Adjunctive intravesical oxybutynin therapy increased the mean total bladder capacity and decreased bladder pressure in children with neurogenic bladders. However, identified studies offered a low level of evidence; most were poorly reported retrospective case series with potential biases. Although the incidence of harm was lower with the intravesical route, they are still possible and should be discussed with patients and families. The evidence in this review is insufficient to recommend this therapy. Research of more sound study design such as a RCT should be conducted to assess the efficacy and harms of intravesical oxybutynin in children.
Table 1. POS-02.119
UROLOGY 70 (Supplment 3A), September 2007
POS-02.120 Status quo of repeated botulinumtoxin injections in spina bifida children with detrusor hyperreflexia: long term follow up Laschke S, Carl S 1 NUKS Neurourological Center, Emmendingen, Germany Introduction: The efficiency of botulinum toxin A in children with spina bifida and detrusor hyperreflexia is proven in several studies. But what happens to children with repeated injections over five years? Methods: Basic studies were standardised urodynamic examination according to ICS criteria. CIC was instituted as initial treatment. Low compliance situation was determined, renal function was evaluated by serum creatinin levels and MAG-3 renal scans. A questionnaire of life score was established. Injections were repeated after six month. Results: In nearly all cases (19/20) good results were found with complete suppression of the hyperreflexic detrusor activity. Conclusions: Botulinum-toxin A (Dysport R) injection in detrusor hyperreflexia mmc-children is a good accepted, very effective and potent therapeutic option also for repeated injections over years to prevent children from bladder augmentation or urinary diversion. POS-02.121 Results of continent vesicostomy as a newer alternative to appendicovesicostomy for Mitrofanoff procedure Irani D Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran Introduction: We present our experience using continent vesicostomy as a Mitrofanoff technique to creat a continent catheterizable stoma as an adjunct to continent urinary tract reconstruction in children and young adults. Methods: Between Sept. 2000 and March 2006, a total of 15 patients (8 male, 7 female) 4 to 20 years old (mean age 9) underwent the Mitrofanoff procedure using a modification of the Cain and Casale vesicostomy. The technique of continent vesicostomy involved a 2 to 3 cm extravesical detrusor muscle and mucosal tube and a 3 cm. intravesical mucosal tube within a submucosal tunnel to provide the continence mechanism. The diagnoses were neurogenic bladder in 11 cases, bladder exstrophy in 2, valve bladder in 1 case
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