The data in this report demonstrate that injection of botulinum toxin into both the external urethral sphincter and the detrusor may be more beneficial than injection into the detrusor alone. One might have thought that relaxation of the external urethral sphincter would result in more incontinence between catheterizations, but that does not seem to be the case. A significant advantage is that postvoid residuals are lower in children who voluntarily void, which could decrease the incidence of recurrent urinary infections in some children. There were also slightly better improvements in the level of continence and grade of vesicoureteral reflux.
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