• 作者：A. Parente ; ^{parente80@hotmail.com} ; J.M. Angulo ; R.M. Romero ; S. Rivas ; C. Corona ; A.R. Tardá ; guila
• 关键词：Toxina botulí ; nica ; Derivació ; n urinaria ; Valvas de uretra posterior
• 刊名：Actas Urol贸gicas Espa帽olas
• 出版年：2011
• 期刊代码：pca37_02104806
• 类别：med
• 出版时间：July-August 2011
• 卷：35
• 期：7
• 页码：429-433
• 文件大小：649 K

lass="h4">Introduction

The closure of urinary diversions performed on newly born infants has a notable failure percentage in patients with bladder disease. We present the use of botulinum toxin as a useful and minimally invasive alternative to treat these patients.

lass="h4">Material and methods

We present two patients with a single kidney and with posterior urethral valves (PUV), in whom it was necessary to perform a ureterostomy due to chronic kidney disease. In both patients, the subsequent attempt to close the diversion failed. Aged 4 and 10 years respectively, they presented bladders commonly known as 鈥渄ry bladders鈥? with a low capacity (20 and 110 ml), bad adaptation (1.5 and 3.1 ml/ cm H₂O) and high opening detrusor pressure. A 10 UI/Kg botulinum toxin A puncture was applied in the detrusor on one and two occasions respectively, prior to the closure of the diversion.

lass="h4">Results

Neither of the patients suffered clinical or ecographic worsening after the closure of the diversion and their kidney function continued without change with respect to the first diversion after one and four years of follow-up respectively. One year after the surgical procedure, video urodynamics showed a significant improvement in bladder capacity (451 and 250 ml), in adaptation (20.4 and 81.9 ml/cmH₂O) and in the opening detrusor pressure.

lass="h4">Conclusions

The closure of high urinary diversions has a high failure percentage in infants with pathological high-pressure bladders. Botulinum toxin may be useful as bladder treatment prior to closure of the diversion, especially in patients with a single kidney.