Efficacy and safety of Botulinum-A Toxin for treating bladder hyperactivity in children and adolescents with neuropathic bladder secondary to myelomeningocele.

Abstract We verified the efficacy and safety of Botulinum-A toxin A (BT-A) in treating children with neuropathic bladder secondary to myelomeningocele. There were 47 patients out of 68 with neuropathic bladder, (22 females, 25 males, age range 5-17 years, mean age 10.7 years, with hypertonic/hyperactive neurogenic bladder detrusor hyperactivity, on clean intermittent catheterization, and resistant or non compliant to anticholinergics. 10 patients presented 2nd to 4thgrade concomitant monolateral/bilateral vesicoureteral reflux (VUR). All patients were incontinent despite catheterization. BT-A was administered by intradetrusoral injection of 200 IU of toxin in 20 sites. Follow-up including clinical, ultrasound, urodynamics was performed at 6, 12 and 24 weeks and annually thereafter.7 patients remained stable, 22 patients required a 2nd injection after 6-9 months and 18 a 3rd injection. VUR was corrected, when necessary, in the same session after Botox injection, by 1 to 3cc of subureteral dextranomer/hyaluronic acid copolymer (Deflux). Urodynamic parameters considered has been leak point pressure (LPP), leak point volume (LPV) and specific volume at 20 cmH2O pressure. The results were analyzed using the Wilcoxon test. All patients experienced a significant 66.45% average increase of LPV (Wilcoxon paired rank test=7,169 e-10) and a significant 118.57% average increase of SC 20 (Wilcoxon paired rank test=2.466 e-12). Difference between preoperative and postoperative LPP resulted not significant (Wilcoxon paired rank test=0.8858) The reflux was cured by one or two injection of Deflux. 38 out of 47 patients achieved dryness between CIC, 9 patients improved their incontinence but still need pads.