The Effects and Side-Effects of Endoscopic Application of Botulinum Toxin-A In Children with Neurogenic Bladder

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Purpose To evaluate the effects and side-effects of endoscopic application of Botulinum-A toxin in the treatment of overactive neurogenic bladder in children. Material and Methods A prospective, non placebo controlled study, conducted with the approval of a Local Ethics Committee. 142 procedures of endoscopic, intradetrusor injections of BTX were performed on 49 girls, and 37 boys, with neurogenic bladder overactivity, aged 1-14 years (mean age 6,4 years). In all of children decreased bladder capacity and detrusor overactivity with urine incontinence were estimated in cystometries despite of oral oxybutynin treatment. In 29 children one injection was performed, in the rest one or more re-injections were performed. Two products were used in weight dependent dosage: Dysport, Ipsen up to 50 U/ kg, Botox, Allergan up to 10 U/ kg body weight. The dose was diluted in 10 ml 0.9% NaCl and injected in 20 sites of bladder dome. We compared pre and post-procedure: volumes of catheterized urine, volumes, pressures from cystometries. Statistical analyses were performed using nonparametric tests: the Wilcoxon signed rank sum test and the U Mann-Whitney test. A p-value of less than 0.05 was considered statistically significant. Results Values of neuro-urologic parameters (catheterized bladder volumes, cystometric bladder capacity, detrusor pressure) improved significantly in 76 to 81% of patients after therapy (p Conclusions Endoscopic administration of Botulinum-A toxin improves functional parameters of neurogenic bladder in children. It represents an alternative to surgical augmentation of bladder and reduction of intravesical pressures.