Abstract
Our experience with off-label use of botulinum toxin continues to grow. As our experience using this treatment for neurogenic and non-neurogenic overactive bladder increases, we find that, while certain questions are being answered, more questions are surfacing. The pediatric urological literature has shown that patients injected with botulinum toxin demonstrate a reduction in incontinence episodes, an increase in bladder capacity, and a reduction in dangerous detrusor pressures—results that appear to last 6-9 months. The questions that remain to be answered center on technique, location of injection, risk of incomplete bladder emptying, and need for clean intermittent catheterization, the risk of systemic side effects, and the long-term outcome of repeat injections. In a recent review, the amount of botulinum toxin type A (BTX-A), Botox, injected most commonly was 10-12 U/kg, with a maximum dose of 300 U, usually in the form of 30 injections of 10 U/mL in the bladder, excluding the trigone. Most of these patients were injected under local anesthesia. 1 Gamé X. Mouracade P. Chartier-Kastler E. et al. Botulinum toxin-A (Botox®) intradetrusor injections in children with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. J Pediatr Urol. 2009; 5: 156-164 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar Another recent study showed a significant improvement in the quality of life of patients injected with Botox and a 43% incidence of clean intermittent self-catheterization (a postvoid residual greater than 100 mL with lower urinary tract symptoms). 2 Khan S. Kessler T.M. Apostolidis A. et al. What a patient with refractory idiopathic detrusor overactivity should know about botulinum neurotoxin type A injection. J Urol. 2009; 181: 1773-1778 Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar Intravesical Injections of Botulinum Toxin Type A for Management of Neuropathic Bladder: A Comparison of Two MethodsUrologyVol. 76Issue 1PreviewTo evaluate and compare the efficacy of botulinum toxin intravesical injections with and without injections in external urethral sphincter in treating bladder hyper-reflexia in children suffering from myelomeningocele. Full-Text PDF ReplyUrologyVol. 76Issue 1PreviewWe agree that still there is a lot to be understood considering the injections of botulinum toxin type A (BT-A) for treating hyperactive bladder in children with neuropathic bladder. For revealing more aspects of this subject researches are ongoing at ur center for providing information for further perception of this management. Moreover, we have designed a randomized clinical trial, comparing the results of 3 groups of children receiving injections of BT-A into detrusor only, external urethral sphincter only, and both. Full-Text PDF
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