1125: Botulinum Toxin a in Neurogenic Bladder: Are there any Patient Predictors of Response?

Although, the role of Botulinum Toxin-A in the treatment of the neurogenic and non-neurogenic neurogenic bladder is becoming more defined, this is the first review article to characterize the emerging role of Botulinum Toxin-A in the pediatric urologic population. Injection of Botulinum Toxin-A at the level of the bladder works by inhibiting uninhibited bladder contractions and, possibly, by blocking some of the sensory nerve fibers. In children with sphincter dyssynergy, injection at the level of the urethral sphincter works by inhibiting the involuntary guarding reflex and blocking dyssynergic voiding.

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Repeated Injection of Botulinum Toxin a in Patients with Neurogenic Bladder: Our Experience

Urologia Journal ◽

10.5301/ru.2012.9383 ◽

2012 ◽

Vol 79 (19_suppl) ◽

pp. 9-14

Author(s):

Ubaldo Cantoro ◽

Daniele Minardi ◽

Vito Lacetera ◽

Alessandro Conti ◽

Francesco Catanzariti ◽

...

Keyword(s):

Botulinum Toxin ◽

Neurogenic Bladder ◽

Botulinum Toxin A ◽

Repeated Injection ◽

Toxin A

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Predictors of Response to Intradetrusor Botulinum Toxin-A Injections in Patients with Idiopathic Overactive Bladder

Advances in Urology ◽

10.1155/2009/328364 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 10

Author(s):

Brian L. Cohen ◽

Daniel J. Caruso ◽

Prashanth Kanagarajah ◽

Angelo E. Gousse

Keyword(s):

Botulinum Toxin ◽

Overactive Bladder ◽

Older Patients ◽

Botulinum Toxin A ◽

Univariate Analysis ◽

Secondary Analysis ◽

Toxin A ◽

Future Studies ◽

Predictors Of Response ◽

Urodynamic Parameters

Objectives. To evaluate whether there are any demographic or urodynamic differences in patients with idiopathic overactive bladder (I-OAB) that respond and do not respond to intradetrusor injections of botulinum toxin-A (BTX-A).Methods. This represents a secondary analysis of data collected from an investigator initiated randomized trial designed to evaluate clinical differences in outcomes for 100 versus 150 U BTX-A in patients with I-OAB. Preinjection demographic and urodynamic data were collected. Patients were evaluated 12 weeks after injection and were determined to be responders or nonresponders as defined by our criteria. Statistical comparisons were made between groups.Results. In patients with overactive bladder without incontinence (OAB-Dry), there were no variables that could be used to predict response to BTX-A. On univariate analysis, younger patients with overactive bladder with incontinence (OAB-Wet) were more likely to respond to BTX-A than older patients. However, this relationship was no longer statistically significant on multivariate analysis.Conclusions. We were unable to identify any preinjection demographic or urodynamic parameters that could aid in predicting which patients will achieve clinical response to BTX-A. Future studies are necessary to further evaluate this question.

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Efficacy and Safety of Botulinum Toxin A for Treating Bladder Hyperactivity in Children and Adolescents with Neuropathic Bladder Secondary to Myelomeningocele

Dataset Papers in Medicine ◽

10.1155/2013/580927 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Antonio Marte ◽

Micaela Borrelli ◽

Maurizio Prezioso ◽

Lucia Pintozzi ◽

Pio Parmeggiani

Keyword(s):

Botulinum Toxin ◽

Neurogenic Bladder ◽

Botulinum Toxin A ◽

Invasive Procedure ◽

Bladder Capacity ◽

Rank Test ◽

Clean Intermittent Catheterization ◽

Efficacy And Safety ◽

Average Increase ◽

Toxin A

We verified the efficacy and safety of botulinum toxin A (BTX-A) in treating bladder overactivity in children with neurogenic bladder (NB) secondary to myelomeningocele (MMC). Forty-seven patients (22, females; 25, males; age range, 5–17 years; mean age, 10.7 years) with poorly compliant/overactive neurogenic bladder on clean intermittent catheterization (CIC) and resistance or noncompliant to anticholinergics were injected with 200 IU of BTX-A intradetrusor. All patients experienced a significant 66.45% average increase of leak point volume (Wilcoxon paired rank test = 7.169 e-10) and a significant 118.57% average increase of specific bladder capacity at 20 cm H2O (Wilcoxon paired rank test = 2.466 e-12). Ten patients who presented with concomitant uni/bilateral grade II–IV vesicoureteral reflux were treated at the same time with Deflux. No patient presented with major perioperative or postoperative problems. Twenty-two patients needed a second and 18 a third injection of BTX-A after 6–9 months for the reappearance of symptoms. After a mean follow-up of 5.7 years, 38 out of 47 patients achieved dryness between CICs, and 9 patients improved their incontinence but still need pads. Our conclusion is that BTX-A represents a viable alternative to more invasive procedure in treatment of overactive NB secondary to MMC.

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