Electromotive drug administration (EMDA) presents a minimally invasive method of intravesical instillation of therapeutic agents without the need for general anesthesia.<sup>1Kos B., Vasquez J.L., Miklavcic D., Hermann G.G., Gehl J. Investigation of the mechanisms of action behind Electromotive Drug Administration (EMDA) PeerJ 2016 ;  4 : e2309

Cliccare qui per andare alla sezione Riferimenti</sup> It employs a combination of iontophoresis, electrophoresis, and electroporation to deliver drugs into deep tissue layers using an electrical current created between 2 electrodes.<sup>2CADTH Rapid Response Reports The Use of the Electromotive Drug Administration System in Patients with Overactive Bladder: A Review of the Clinical Effectiveness, Safety, and Cost-Effectiveness  Ottawa (ON): Canadian Agency for Drugs and Technologies in Health Copyright (c) 2014 Canadian Agency for Drugs and Technologies in Health. (2014). 

Cliccare qui per andare alla sezione Riferimenti</sup> This video shows feasibility of botulinum toxin type A (BoNTA) EMDA in myelomeningocele children with urinary incontinence secondary to neuropathic detrusor overactivity.

In this technique (Video 1), catheterization was performed with a 10-Fr (CE-DAS, UROGENICS/Ag 9900 (pediatric), Mirandola, Italy) catheter electrode, after providing a local transurethral anesthesia with 2% lidocaine gel. The cuff of the catheter was filled by 2 cc saline solution. The bladder was then drained and irrigated with 0.9% saline solution until the catheter outflow became clear. The bladder was subsequently filled with sterile water to its maximal capacity. BoNTA (Dysport) at a dose of 10 IU/kg was added to the intravesical solution. Negative electrode as 2 dispersive electrodes was placed on the abdomen. Positive electrode was connected to the intravesical catheter. A pulsed current generator (Physionizer 30, Physion srl, Mirandola, Italy), delivered a current with frequency of 2,800 Hz, interval of 50 µs and amplitude of 10-20 mA for 20 minutes. At the end of the procedure, the bladder was emptied.

For the first time, BoNTA/EMDA was performed on myelomeningocele patients with urinary incontinence in our center.<sup>3Kajbafzadeh A.M., Ahmadi H., Montaser-Kouhsari L., Sharifi-Rad L., Nejat F., Bazargan-Hejazi S. Intravesical electromotive botulinum toxin type A administration – part II: clinical application Urology 2011 ;  77 : 439-445 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> According to our prior reports, urinary incontinence improved in 75% of the patients between 2 consecutive clean intermittent catheterizations at 1-year follow-up.<sup>4Ladi-Seyedian S.S., Sharifi-Rad L., Kajbafzadeh A.M. Intravesical electromotive botulinum toxin type "A" administration for management of urinary incontinence secondary to neuropathic detrusor overactivity in children: long-term follow-up Urology 2018 ;  114 : 167-174 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> Mean maximal cystometric capacity significantly increased from 148 ± 62 mL at baseline to 239 ± 73 mL 1 year after the treatment.<sup>4Ladi-Seyedian S.S., Sharifi-Rad L., Kajbafzadeh A.M. Intravesical electromotive botulinum toxin type "A" administration for management of urinary incontinence secondary to neuropathic detrusor overactivity in children: long-term follow-up Urology 2018 ;  114 : 167-174 [cross-ref]

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This technique is a feasible, safe, reproducible, cost effective, long lasting, and pain free method, on an outpatient basis with long-term duration of effects and without anesthesia or cystoscopy procedure.