Vesicoureteral refulx in overactive bladder: medical resolution through botulin toxin injection

Miguel Angel Arrabal-Polo, Mercedes Nogueras-Ocaña, Antonio Jiménez-Pacheco, Francisco Palao-Yago, Javier Tinaut-Ranera, Victor López-León, Armando Zuluaga-Gómez
Archivos Españoles de Urología 2012, 65 (9): 844-8

OBJECTIVE: Overactive bladder may have a neurogenic or non neurogenic origin. Sometimes, as a result of detrusor overactivity, disorders of the upper urinary tract function may appear. One of these alterations may be the appearance of associated vesicoureteral reflux. The treatment of overactive bladder may be done with anticholinergic drugs and if there is not response the use of botulin toxin type A is approved. The aim of this case report is to demonstrate the effect of botulin toxin type A in the treatment of overactive bladder and vesicoureteral reflux secondary to the overactive bladder.

METHOD: We present the case of a 10-year-old patient without significant past medical history. When he was one year old he had a urinary infection and voiding cystourethrogram showed grade 1 right vesicoureteral reflux. When he was 4 year old he presented several episodes of pyelonephritis and then he was diagnosed of severe bilateral vesicoureteral reflux, which did not respond to treatment with Macroplastic ® or Deflux ®. Urodynamic study was performed showing overactive bladder with decreased bladder compliance.

RESULTS: We performed intravesical injection of 200 U of botulin toxin type A and vesicoureteral reflux disappeared and urodynamic study improved. One year later we re-injected botulin toxin type A (300 U) and we repeated the injection after one year (300 U). The patient is currently well, without changes in the urodynamic study and without vesicoureteral reflux.

CONCLUSION: Repeated injections of botulin toxin type A has shown great efficacy in the treatment of overactive bladder in children with vesicoureteral reflux improved secondary.

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