OBJECTIVE: To evaluate clinical and urodynamic efficiency of onabotulinumtoxinA (Botox) treatment in pediatric patients with urinary incontinence due to neurogenic overactive bladder.
PATIENTS AND METHODS: Seventeen patients aged from 6 to 17 years (median 11 years) were treated with Botox injections. Clinical response to incontinence, duration of the response, and urodynamic results before and 1-3 months after treatment were evaluated.
RESULTS: Mean incontinence frequency decreased significantly (p = 0.036); six of 17 patients had >90% reduction, and a further three patients had a 50-90% reduction in incontinence episodes. Median duration of the response was 15 months (range 3-42 months). Mean bladder volume changed from 380 ± 148 ml to 453 ± 147 (p = 0.078), maximal detrusor pressure decreased from 45 ± 31 cmH2O to 32 ± 21 cmH2OO (p = 0.030), and the number of patients with detrusor contractions during filling decreased from 12 to three (p = 0.005) after the treatment. The patients with poor bladder compliance had either no response or a short duration of response. At follow-up eight patients had undergone bladder augmentation because of persistent incontinence.
CONCLUSIONS: About one third of pediatric patients with neurogenic bladder had a good response to Botox treatment. In many patients, the clinical response was longer than expected. The patients who initially had poor bladder compliance had a poor response to the treatment.
Written by:
Kask M, Rintala R, Taskinen S. Are you the author?
Children's Hospital, University of Helsinki, Helsinki, Finland.
Reference: J Pediatr Urol. 2013 Sep 30. pii: S1477-5131(13)00232-5.
doi: 10.1016/j.jpurol.2013.09.004
PubMed Abstract
PMID: 24095686
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