Use of botulotoxine type A in the treatment of a child with infravesical obstruction of the urinary tract

The most common cause of infravesical obstruction in children is the posterior urethral valve. At least a third of patients with this diagnosis by puberty face the progression of chronic kidney disease and dilation of the upper urinary tract. The most likely cause of the listed complications is intrauterine urethral obstruction, which affects the development of the entire urinary tract. Compliance with diagnostic and treatment algorithms can lead to a decrease in complications in this group of children and an increase in their quality of life.

The report aims to illustrate the successful comprehensive and staged treatment of a patient with a posterior urethral valve using chemodenevation of the bladder detrusor.

Materials and methods. A clinical case of the treatment of a 2-year-old patient with a posterior urethral valve and a subclinical infectious process is presented. The patient received surgical care using intraluminal endosurgical methods and surgical interventions with open traditional correction methods, without taking into account the age, anatomical, and pathophysiological features of the urinary tract. These errors subsequently led to the development of chronic kidney disease stage 3. Moving forward, the child required rehabilitation and preoperative correction of complications to prepare for the repeated radical elimination of urinary diversion disorders and the restoration of urinary tract urodynamics.

Results. The child underwent successful surgical treatment using a combined endosurgical approach after staged chemodenervation of the bladder detrusor with Botulinum toxin type A. This included extravesical mobilization of the ureters on both sides and the classic correct formation of ureterocystoanastomosis according to the Cohen method. In the 1.5-year follow-up, a significant improvement in the urine passage through the urinary tract, relief of the infectious process, stabilization of nitrogen metabolism parameters, and glomerular filtration rate are noted.

Conclusion. Logistics and surgical treatment of such a complex developmental defect as the posterior urethral valve should always be built taking into account the age-specific anatomy and the characteristics of pathological changes in order to achieve the desired goal.

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