Treatment for neurogenic bladder (NGB) has been expanded with the introduction of intra-detrusor onabotulinumtoxinA injections. Herein we review our experience with this procedure for cases in which maximal anti-cholinergic therapy failed or was not tolerated.
We prospectively enrolled 17 patients who underwent onabotulinumtoxinA injections over a 4-year period. Demographic information, number of injections, and dose of onabotulinumtoxinA employed were captured. Children were monitored with baseline and post-injection renal ultrasound, urodynamics, and assessed for side effects, satisfaction and symptom improvement.
A total of 43 sessions were performed with injections repeated every ~6 months. Mean patient age was 10.7 years (3-17). Following the first injection, mean bladder capacity adjusted for age and compliance improved by 27%(p=0.039) and 45.2%(p=0.041). After subsequent injections, with a higher mean dose of 21.1 units these values increased to 35.7% (p=0.043) and 55.1% (p=0.091) respectively. Clinical improvement of ≥50% was seen in 10 children (76.9%). However, 3 patients in whom the dose of onabotulinumtoxinA was reduced to 200 units all complained of recurrent symptoms. Fourteen children (82.3%) avoided surgical reconstruction as a second line of treatment. No complications or upper tract deterioration were found associated to this procedure.
Intra-detrusor onabotulinumtoxinA injection is a promising intervention for management of NGB in selected children who would have otherwise been candidates for surgical reconstruction. Our data demonstrates improvement in symptoms and urodynamic parameters. Although an optimal dose has not been determined for pediatric patients, we found better response with treatment close to 10 units/kg.