OBJECTIVE: To investigate urodynamic (UD) parameters that predict outcome of intradetrusor botulinum toxin-A (BTX-A) injection in children with neurogenic detrusor overactivity (NDO), by reviewing clinical and UD data.
METHODS: From January 2010 to March 2014, 56 cases of the first BTX-A intradetrusor injection were performed in pediatric patients with NDO. We excluded 19 cases based on these criteria: patient age < 4 years, no preoperative UD study or postoperative outcome assessment, and simultaneous sphincter injection. Based on the Patient Global Impression of Improvement, patients were classified as responders or nonresponders.
RESULTS: Thirty-seven cases were included finally. Mean number of pads used per day was significantly decreased after BTX-A injection (2.67 ± 1.46 vs 1.37 ± 1.15; P < .001). On postoperative UD study, maximum cystometric capacity and residual urine volume were significantly increased above baseline. Persistent NDO was only detected in 3 cases (8.1%). Regardless of UD improvements, 20 cases were responders, whereas 17 were nonresponders based on Patient Global Impression of Improvement. Preoperative bladder compliance was significantly lower in nonresponders (25.11 ± 32.59 vs 8.64 ± 6.52; P = .039). Open bladder neck (OBN) was seen in 9 cases and more likely occurred in nonresponders. Regression analysis revealed that poor bladder compliance (< 10 mL/cm H2O; odds ratio, 6.041; 95% confidence interval, 1.189-30.677; P = .030) and presence of OBN (odds ratio, 16.889; 95% confidence interval, 1.825-156.282; P = .031) were independent predictors of poor response after BTX-A injection.
CONCLUSION: Preoperative bladder compliance and OBN were important predictors of outcome after BTX-A intradetrusor injection. Thus, intradetrusor BTX-A injection should be considered in select patients to achieve optimal outcome.
Written by:
Kim SW, Choi JH, Lee YS, Han SW, Im YJ. Are you the author?
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
Reference: Urology. 2014 Dec;84(6):1480-4.
doi: 10.1016/j.urology.2014.09.001
PubMed Abstract
PMID: 25432842