The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor

Purpose: We determined the effect of detrusor injection of botulinum-A toxin in a cohort of children with therapy resistant nonneurogenic detrusor overactivity. This prospective study included therapy resistant children with overactive bladder. Material and Methods: During the study period of 19 months 10 boys and 11 girls were included. All patients showed decreased bladder capacity for age, urge and urge incontinence. Main treatment duration before inclusion was 45 months. A dose of 100 U botulinum-A toxin (Botox (R)) was injected in the detrusor. Results: Side effects were evaluated in all 21 included patients. The side effects reported were 10-day temporary urinary retention in I girl and signs of vesicoureteral reflux with flank pain during voiding in I boy, which disappeared spontaneously after 2 weeks. No further examinations were done since the boy refused. Two girls experienced I episode each of symptomatic lower urinary tract infection. Eight girls and 7 boys with a minimum followup of 6 months represent the study group for long-term evaluation. In this study group after 1 injection 9 patients showed full response (no more urge and dry during the day) with a mean increase in bladder capacity from 167 to 271 ml (p < 0.001). Three patients showed a partial response (50% decrease in urge and incontinence) and 3 remained unchanged. Eight of the 9 full responders were still cured after 12 months, while 1 of the initially successfully treated patients had relapse after 8 months. The 3 partial responders and the patient with relapse underwent a second injection with a full response in the former full responder and in 1 partial responder. Conclusions: Botulinum-A toxin injection in children with nonneurogenic overactive detrusor is an excellent treatment adjunct, leading to long-term results in 70% after 1 injection.