This Month in Pediatric Urology.

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 Apr 2023This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003184AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Naturally occurring substances being adapted to medicinal use is part of the lore of biomedical science. Penicillin was once just a term referring to secretion from the mold, Penicillium notatum. In 1928, Alexander Fleming fortuitously recognized the presence and importance of the bactericidal band around the mold that had contaminated a culture plate of Staphylococcus aureus.1 This finding along with the work being done on sulfonamides ushered in the antibiotic era. In a similar fashion, botulinum toxin found its way into therapeutic use. Botulism is an uncommon but potentially fatal condition resulting typically from the ingestion of botulinum toxin produced by Clostridium botulinum bacteria.2 One of the characteristic symptoms is weakness of the eye muscles with drooping eyelids. Among infants, it creates so-called floppy baby syndrome and led to a recommendation of avoiding feeding honey to infants under age 1 year due to it acting as a reservoir of C botulinum spores. This early clinical presentation in eye muscles and muscle weakness led to interest in using the purified toxin (onabotulinumtoxin A) to treat strabismus.3 Success there led to applications elsewhere including the treatment of dysfunctional bladders and has led to calls for wider use in pediatric urology.4 Franco et al (page 774) in a multi-institutional study report on the long-term safety and tolerance of repeated cystoscopic intradetrusor injections of botulinum toxin in the treatment of children with neurogenic bladder overactivity.5 They found that the injections were well tolerated and there were few serious treatment-related adverse events; notably the development of urinary tract infection was similar to the rate seen prior to injection. These findings confirm what many pediatric urologists have already known when using botulinum toxin in this manner but may serve as an important step in adding it formally to the available treatment options. The data may help garner regulatory approval, thereby broadening acceptance with third-party payers, and allow wider access and use. REFERENCES 1. . New light on the history of penicillin. Med Hist. 1982; 26(1):1-24. Crossref, Medline, Google Scholar 2. . Clostridium botulinum and the clinical laboratorian: a detailed review of botulism, including biological warfare ramifications of botulinum toxin. Arch Pathol Lab Med. 2004; 128(6):653-662. Crossref, Medline, Google Scholar 3. . Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery. Ophthalmology. 1980; 87(10):1044-1049. Crossref, Medline, Google Scholar 4. . It is time to liberalize the administration of botulinum toxin in the pediatric urology clinic!. J Urol. 2022; 208(3):534-535. Link, Google Scholar 5. . Long-term safety and tolerability of repeated treatments with onabotulinumtoxinA in children with neurogenic detrusor overactivity. J Urol. 2023; 209(4):774-784. Link, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue 4April 2023Page: 655-655 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julian Wan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...