Botulinum toxin type A for neurogenic detrusor overactivity due to spinal cord lesions in children: A retrospective study of seven cases

Objective: To assess the effectiveness and safety of intradetrusor injections of botulinum toxin type A (BTA) used to treat neurogenic detrusor overactivity in children. Patients and methods: We retrospectively reviewed the records of seven children treated at least once (7/7: one injection; 4/7: two and three injections; 2/7: four injections; 1/7: five injections) with intradetrusor BTA injections in 2005-2008, for neurogenic detrusor overactivity with incontinence despite timed bladder catheterizations and anticholinergic agents. Clinical, urodynamic, and imaging study data at baseline were collected. Clinical efficacy criteria were the urinary tract infection (UTI) rate, continence, and need for anticholinergic agents. The following urodynamic data were assessed: maximum catheterized volume without leakage, reflex volume, maximum detrusor pressure, and bladder compliance. Results: Seven children received 18 injections. Social continence was achieved from the first injection. No further recurrent lower UTIs occurred. Maximum catheterized volume and reflex volume increased, and maximum detrusor pressure decreased. Detrusor compliance became interpretable and increased. Grade II right vesicoureteral reflux, present at baseline in one patient, resolved after BTA therapy. UTIs were the only adverse effects. Conclusion: Injection with BTA proved effective and safe in the short term. This may be an alternative to surgery in children with neurogenic detrusor overactivity. (C) 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.