TY - JOUR
T1 - Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children
T2 - Effect of dose adjustment, multiple injections, and avoidance of reconstructive procedures
AU - Figueroa, V.
AU - Romao, R.
AU - Pippi Salle, J. L.
AU - Koyle, M. A.
AU - Braga, L. H.P.
AU - Bägli, D. J.
AU - Lorenzo, A. J.
PY - 2014/4
Y1 - 2014/4
N2 - Objective: Since 2007, intra-detrusor OnabotulinumtoxinA (OnabotA) injections have been selectively offered at our institution for cases in which maximal anticholinergic therapy failed or was not tolerated. Herein we present our experience with this approach. Materials and methods: We prospectively obtained data on 17 patients who underwent OnabotA injections over a 4-year period. Demographic information, number of injections, and dose delivered were captured. Children were monitored with baseline and post-injection renal ultrasound, urodynamics, and assessed for side effects, satisfaction, and symptom improvement. Results: Forty-three sessions were performed with injections given every ∼6 months. Mean patient age was 10.7 years (range, 3-17). Compared with baseline, after the first injection, mean bladder capacity adjusted for age and compliance improved by 27% (p = 0.039) and 45.2% (p = 0.041), respectively. After subsequent injections, these values increased to 35.7% (p = 0.043) and 55.1% (p = 0.091), respectively. Out of 13 symptomatic patients, ≥50% improvement was reported in ten (76.9%) and complete resolution in seven (53.8%). However, all three patients in whom the maximum dose of OnabotA was reduced from 300 to 200 units complained of recurrent symptoms. Fourteen children avoided surgical reconstruction as a second line of treatment. Overall patient/parental reported satisfaction rate was 70.6% (12/17). Conclusions: Intra-detrusor OnabotA injection is a promising intervention for management of neuropathic bladder in selected patients. Our data demonstrate improvement in symptoms and urodynamic parameters. Although an optimal dose has not been determined for children, we found optimal response with a maximum administration of OnabotA up to 300 units.
AB - Objective: Since 2007, intra-detrusor OnabotulinumtoxinA (OnabotA) injections have been selectively offered at our institution for cases in which maximal anticholinergic therapy failed or was not tolerated. Herein we present our experience with this approach. Materials and methods: We prospectively obtained data on 17 patients who underwent OnabotA injections over a 4-year period. Demographic information, number of injections, and dose delivered were captured. Children were monitored with baseline and post-injection renal ultrasound, urodynamics, and assessed for side effects, satisfaction, and symptom improvement. Results: Forty-three sessions were performed with injections given every ∼6 months. Mean patient age was 10.7 years (range, 3-17). Compared with baseline, after the first injection, mean bladder capacity adjusted for age and compliance improved by 27% (p = 0.039) and 45.2% (p = 0.041), respectively. After subsequent injections, these values increased to 35.7% (p = 0.043) and 55.1% (p = 0.091), respectively. Out of 13 symptomatic patients, ≥50% improvement was reported in ten (76.9%) and complete resolution in seven (53.8%). However, all three patients in whom the maximum dose of OnabotA was reduced from 300 to 200 units complained of recurrent symptoms. Fourteen children avoided surgical reconstruction as a second line of treatment. Overall patient/parental reported satisfaction rate was 70.6% (12/17). Conclusions: Intra-detrusor OnabotA injection is a promising intervention for management of neuropathic bladder in selected patients. Our data demonstrate improvement in symptoms and urodynamic parameters. Although an optimal dose has not been determined for children, we found optimal response with a maximum administration of OnabotA up to 300 units.
KW - Children
KW - Incontinence
KW - Intravesical drug administration
KW - Neuropathic bladder
KW - OnabotulinumtoxinA
UR - http://www.scopus.com/inward/record.url?scp=84898801903&partnerID=8YFLogxK
U2 - 10.1016/j.jpurol.2013.10.011
DO - 10.1016/j.jpurol.2013.10.011
M3 - Artículo Científico
C2 - 24280272
AN - SCOPUS:84898801903
SN - 1477-5131
VL - 10
SP - 368
EP - 373
JO - Journal of Pediatric Urology
JF - Journal of Pediatric Urology
IS - 2
ER -