Eur J Pediatr Surg 2010; 20(3): 153-157
DOI: 10.1055/s-0029-1246193
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Effectiveness of Botulinum-A Toxin for the Treatment of Refractory Overactive Bladder in Children

A. Marte1 , M. Borrelli1 , M. D. Sabatino1 , B. D. Balzo1 , M. Prezioso1 , L. Pintozzi1 , F. Nino1 , P. Parmeggiani1
  • 1Pediatric Surgery-Second University of Naples, Pediatrics, Naples, Italy
Further Information

Publication History

received August 05, 2009

accepted after revision December 01, 2009

Publication Date:
28 January 2010 (online)

Abstract

Aims: We describe our experience with botulinum-A toxin (BTX-A) in children presenting idiopathic overactive bladder (OAB) refractory to anticholinergic drugs.

Material and Methods: 21 patients, aged 8–12 years, were treated over a 3-year period. BTX-A was administered at a dosage of 12.5 UI /kg body weight, without exceeding 200 UI, at 20 detrusor sites. To ensure a stable solution, each 100 UI of botulinum toxin was diluted with 5 cc saline solution just prior to performing the cystoscopy.

Results: No patient presented with severe systemic complications or urinary retention after injection therapy; 6 patients presented with slight hematuria for 2–3 days. The clinical results were as follows. At 6 months, 8/21 patients (38%) showed full response, 12/21 (57%) had a partial response after a 2nd injection, and 1/21 (4.7%) showed no response after a 2nd injection. At 12 months, 16 patients (76%) had a full response, 4 (19%) showed a partial response after a 3rd injection, and 1 patient (4.7%) still had no response. At 18 months, 18 patients (85%) showed a full response, 2 patients (9.5%) had a partial response, 1 patient (4.7%) had no response. At the end of this study, 8/21 patients (38%) were symptom-free, after only one botulinum detrusor injection, 13/21 patients (61.9%) received a second botulinum injection because of recurrence of urinary incontinence 6–7 months after the initial treatment, and 4/21 patients (19%) received a third injection 12–14 months after the initial treatment, of whom 2 had a full response and 2 had a partial response. Patient no. 20 refused any further botulinum treatment after the 2nd unsuccessful injection series.

Conclusion: Intravesical BTX-A injection appears to be safe and useful in children presenting with idiopathic overactive drug-resistant bladder.

References

  • 1 Norgard JP, Van Gool DJ, Hjalmas K. et al . for the International Children's Continence Society. Standardization and definitions in lower urinary tract dysfunction in children.  BJU Int. 1998;  81 ((suppl 3)) 1
  • 2 Hoebeke P, Van Laecke E, Van Camp C. et al . One thousand video urodynamic studies in children with nonneurogenic bladder sphincter dysfunction.  BJU Int. 2001;  87 575-580
  • 3 Nijman JM. Role of antimuscarinics in the treatment of non neurogenic daytime urinary incontinence in children.  Urol. 2004;  63 ((suppl 3a)) 45-50
  • 4 Curran MJ, Kaefer M, Peters C. et al . The overactive bladder in childhood: long-term result with conservative management.  J Urol. 2000;  163 ((2)) 574-577
  • 5 Kuo HC. Urodynamic evidence of effectiveness of botulinum-A toxin injection in treatment of detrusor overactivity refractory to anticholinergic agents.  Urol. 2004;  63 ((5)) 868-872
  • 6 Schulte-Baukloh H, Michael T, Schobert J. et al . Efficacy of botulinum-A toxin in children with detrusor hyperreflexia due to myelomeningocele: preliminary result.  Urol. 2002;  59 325-327
  • 7 Marte A, Vessella A, Cautiero P. et al . Efficacy of toxin-A botulinum for treatment intractable bladder hyperactivity in children affected by neuropathic bladder secondary to myelomeningocele: an alternative to enterocystoplasty.  Miner Pediatr. 2005;  57 35-40
  • 8 Hoebeke P, De Caestecker K, Vande Walle J. et al . The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor.  J Urol. 2006;  176 328-331
  • 9 Sureshkumar P, Craig JC, Roy LP. et al . A reproducible pediatric daytime incontinence questionnaire.  J Urol. 2001;  165 569-573
  • 10 DasGupta R, Murphy FL. Botulinum toxin in paediatric urology: a systematic literature review.  Pediatr Surg Int. 2009;  25 ((1)) 19-23
  • 11 Kalisi V, Apostolidis A, Gonzales G. et al . Early effect on the overactive bladder symptoms following botulinum neurotoxin type A injections for detrusor overactivity.  Eur Urol. 2008;  54 ((1)) 181-187
  • 12 Riccabona M, Koen M, Schindler M. et al . Botulinum-A toxin injection into the detrusor: a safe alternative in the treatment of children with myelomeningocele with detrusor hyperreflexia.  J Urol. 2004;  171 845-848
  • 13 Kim HS, Hwang H, Jeon ST. et al . Effect of muscle activity and botulinum-A toxin dilution volume on muscle paralysis.  Dev Med Child Nrurol. 2003;  45 200-206
  • 14 Del Popolo G, Li Mazzi V, Panariello G. et al . Botulinum toxin A in the treatment of neurogenic detrusor overactivity.  33rd Annual meeting of the International Continence Society, Florence, Italy 2003;  Abstract
  • 15 Dmochowski R, Sand PK. Botulinum toxin A in the overactive bladder: current status and future direction.  BJU. 2007;  99 247-262
  • 16 Koff SA. Estimating bladder capacity in children.  Urology. 1983;  21 248
  • 17 Grosse J, Crammer G, Stohrer M. Success of repeat detrusor injection of botulinum-A toxin in patient with severe neurogenic detrusor overactivity and incontinence.  Eur Urol. 2005;  47 653-659
  • 18 Schult-Baukloh H, Knispel HH, Stolze T. et al . Repeated botulinum-A toxin injections in treatment of children with neurogenic detrusor overactivity.  Urol. 2005;  66 865-870

Correspondence

Dr. Antonio Marte

Second University of Naples

Pediatry

Naples

Italy

Email: antonio.marte@unina2.it