Intradetrusor injection of botulinum toxin A in children: a 10-year single centre experience
- 20 Downloads
We evaluated the efficacy and safety outcomes of endoscopic intradetrusor botulinum toxin A (BTA) injections for the treatment of children with neuropathic bladder (NB) and non-neuropathic bladder (NNB) with or without detrusor overactivity in a single centre with a retrospective analysis.
For the period 2006–2015, children who received BTA in our hospital were analysed. They were divided into group 1, those with underlying NB and group 2, those without a clear neuropathic cause of symptoms (NNB). Data are given as percentages or medians (interquartile range).
Over the study period, 52 children (28 boys, 54%) received BTA, 28 in group 1 (54%; 17 (61%) boys) and 24 in group 2 (46%; 11 (46%) boys). Age at first injection was 11.8 (9.5–14.4) years. After initial injection, 40 (77%) reported symptomatic improvement, 17 (43%) becoming dry. There was no significant difference in response to initial injection between groups (p = 0.11). Duration of improvement after first injection was 7 (5.8–14) months. Twenty-five (48%) had further injections, of whom 3 (12%) were initial non-responders. Ongoing improvement was reported in 20 (80%), 11 (44%) of whom were dry. There was no significant difference in overall response to injections between groups (p = 0.11). Of the 11 non-responders, none (0/3) improved after subsequent injection and 3 (27%) subsequently underwent major urological surgery. Of the 40 who responded, 2 (5%) underwent major surgery.
BTA injection produced symptomatic improvement in 77% of our study population, with no significant differences in response between NB and NNB groups. In 95% of those who improved, major urinary tract procedures were avoided during the period studied. None of the initial non-responders improved after subsequent BTA injection. BTA injection is effective and reliable in the management of children with NB and NNB refractory to medical therapy.
KeywordsChildren Urology Botulinum toxin A Overactive bladder Neurogenic bladder
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare. No funding source was involved in this study.
All procedures performed on human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from the parents of each child prior to all the procedures. All parents were informed about the procedure and off-label status of the BTA therapy.
- 6.Nevéus T, von Gontard A, Hoebeke P, Hjälmås K, Bauer S, Bower W et al (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 176:314–324CrossRefGoogle Scholar
- 11.Larijani FJ, Moghtaderi M, Hajizadeh N, Assadi F (2013) Preventing kidney injury in children with neurogenic bladder dysfunction. Int J Prev Med 4:1359–1364Google Scholar
- 16.Figueroa V, Romao R, Pippi Salle JL, Koyle MA, Braga LHP, Bägli DJ et al (2014) Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children: effect of dose adjustment, multiple injections, and avoidance of reconstructive procedures. J Pediatr Urol 10:368–373CrossRefGoogle Scholar
- 17.Mangera A, Apostolidis A, Andersson KE, Dasgupta P, Giannantoni A, Roehrborn C et al (2014) An updated systematic review and statistical comparison of standardised mean outcomes for the use of botulinum toxin in the management of lower urinary tract disorders. Eur Urol 65:981–990CrossRefGoogle Scholar