Es la inyección de Toxina botulínica-A en el detrusor una alternativa a la ampliación vesical en ni？os

introduction: bladder dysfunction causes urinary incontinence and kidney damage in children. when treatment with anticholinergics and intermittent bladder catheterization fails, the alternative therapy is bladder augmentation. patients and methods: between 2005 and 2009, a prospective study was carried out with botox？ injected into the detrusor of children suffering from high-pressure bladder despite anticholinergic treatment. we assessed their urodynamic, clinical and radiological evolution prior to and at 4 weeks, 6 months and 1 year after the injection (10 u/kg of weight up to 300 u). reinjection was indicated in the event of clinical or urodynamic worsening. we employed the wilcoxom test to statistically analyze the urodynamic parameters. results: 12 patients were treated, 11 with neurogenic bladder (91.7%) and 1 with posterior urethral valves (8.4%). the mean age was 12.6 (4.3-17.8) years and follow-up took place after 40.8 (16.9-45-7) months. bladder capacity, detrusor accommodation and pressure improved after 4 weeks in all the patients except in 2 (16.7%). this improvement decreased after 6 months, although successive injections produced similar changes. one patient (8.3%) received 1 dose, six (50%) two doses and five (41.7%) received three. clinical and urodynamic improvement in 8 patients (66.7%) prevented bladder augmentation. conclusions: repeated botulinum toxin injection in the detrusor is a therapeutic instrument for high pressure and low accommodation bladders in children. it could replace bladder augmentation in some cases, however further studies with long-term follow-up care are required to appropriately evaluate its safety and effectiveness.