Abstract
ABSTRACTObjectives: To evaluate the outcome of intradetrusor onabotulinumtoxinA (Botox®; Allergan Inc., Dublin, Ireland) (IDB) injection in children and adolescents with non-neurogenic overactive bladder (OAB) refractory or resistant to treatment.Patients and Methods: In all, 91 patients underwent evaluation using subjective scores and urodynamic studies (UDS), including determination of maximum bladder capacity (MBC) and evaluating the capacity deficit vs the expected bladder capacity (EBC), and uroflowmetry determination of voided volume, maximum urinary flow rate (Qmax) and post-void residual urine volume (PVR). All patients received oxybutynin (0.3–0.5 mg/kg/day) for 3 months and re-evaluated patients who developed drug intolerability, persistence or recurrence of OAB received 100 U IDB injection using 20 injection sites, with trigone and sphincter sparing. All patients were re-evaluated 3-monthly for subjective scoring and at the end of the 12-month follow-up with UDS.Results: In all, 43 patients underwent IDB injection and at the end of the 12-month follow-up the success rate for IDB injection was 90.7%. All patients showed progressively decreasing scores compared to baseline scores. At the 12-month follow-up, MBC, voided volume, and Qmax were significantly higher, whilst capacity deficit and PVR were significantly lower than baseline measures. The frequency of patients satisfied with the outcome of IDB was high.Conclusion: For children with OAB refractory or resistant to biofeedback therapy, anti-cholinergic drugs must be tried first with IDB reserved for cases who fail to respond, are intolerant or recur after medical treatment. IDB using 100 U Botox, at 20 injection sites with trigone and sphincter sparing, is successful with a high satisfaction rate and free of postoperative problems.Abbreviations: EBC: expected bladder capacity; IDB: intradetrusor onabotulinumtoxinA; MBC: maximum bladder capacity; OAB: overactive bladder; OABSS: Overactive Bladder Symptom Score; PPBC: Patient Perception of Bladder Condition; PVR: post-void residual urine volume; TENS: transcutaneous electrical nerve stimulation; Qmax: maximum urinary flow rate; UDS: urodynamic studies; UI: urinary incontinence
Highlights
Non-neurogenic lower urinary tract dysfunction in the paediatric population is very common and is one of the important underlying causes of LUTS, UTI and VUR in affected children [1]
Proper management of children with bladder overactivity depends on detailed history taking; validated questionnaire on voiding, voiding diary, urine analysis, ultrasonography, uroflowmetry and post-void residual urine volume (PVR) measurement, but invasive urodynamic studies (UDS) should be reserved for when standard treatment has failed [3]
Pharmacotherapy for overactive bladder (OAB) should have a better chance of curing various problems and improving self-esteem and quality of life in children with hyperactive bladder [1]
Summary
Non-neurogenic lower urinary tract dysfunction in the paediatric population is very common and is one of the important underlying causes of LUTS, UTI and VUR in affected children [1]. Bladder overactivity can be defined as the presence of voiding urgency, associated with increased daytime frequency and nocturia, with or without urinary incontinence (UI), in the absence of UTI or other obvious pathology [2]. Pelvic floor biofeedback training should be considered the initial treatment option in patients with nonneurogenic overactive bladder (OAB), as it is an effective treatment modality in children with treatment refractory OAB and dysfunctional voiding [5], or can be used as a supplementary to standard urotherapy [1]. Pharmacotherapy for OAB should have a better chance of curing various problems and improving self-esteem and quality of life in children with hyperactive bladder [1]. Oxybutynin, an M-cholinoblocker, is the ‘gold standard’ for the pharmacotherapy of
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