Repeated Intradetrusor Botulinum Toxin Type A in Children With Neurogenic Bladder Due to Myelomeningocele
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Bibliographic record
Abstract
PURPOSE: We evaluated the effect of repeated intradetrusor injections of BTA in pediatric myelomeningocele not responding to medical management. MATERIALS AND METHODS: After baseline history, physical examination and urodynamic assessment BTA was injected (5 IU/kg body weight, maximum 300 IU) at 10 to 30 sites. Clinical and urodynamic assessment was performed at 3 months after each injection. Re-treatment was offered when clinical symptoms returned. RESULTS: A total of 20 patients (average age 13 years) received BTA injections. Of the patients 13 became continent. MBC increased from 215.6 +/- 58.8 cc to 338.3 +/- 98.4 cc (p < 0.01), MDP decreased from 43 +/- 13.7 cm H2O to 21.6 +/- 10.5 cm H2O (p < 0.01) and compliance increased from 5.2 +/- 2.6 ml/cm H2O to 13 +/- 6.9 ml/cm H2O (p < 0.01). At an average of 8.1 months after the first injection all 13 patients received a second injection, which led to similar improvement, ie MBC increased from 200.5 +/- 41.6 cc to 404.2 +/- 57.8 cc (p < 0.001), MDP decreased from 48.18 +/- 6.1 cm H2O to 27.8 +/- 3.7 cm H2O (p < 0.01) and compliance increased from 6.0 +/- 3.1 ml/cm H2O to 15.1 +/- 5.2 ml/cm H2O (p < 0.01). Among the responders 3 received 3 injections and 1 received 4 injections, all of whom exhibited improvement similar to that seen initially. Among our initial cohort of 20 patients 7 failed to improve initially and 6 failed to improve after a second injection. CONCLUSIONS: BTA seems to be a simple and safe way to postpone or avoid invasive procedures in two thirds of children with myelomeningocele not responding to usual medical treatment.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it