A 100 U BTX was diluted in 15 ml of normal saline and injected into the detrusor at 15 sites using a cystoscope and cystoscopic needle. The injection sites were supra-trigonal and with 5 injections in a line 1 cm apart, and 2 more lines of 5 injections placed 1 cm cranial. The ventral bladder was avoided due to it relationship to the peritoneal cavity. This was done under general anesthesia on an outpatient basis.

All 21 children were diagnosed with overactive bladder and had a decreased bladder capacity for their age, urge and urge incontinence, and all had nocturnal incontinence. None were dysfunctional voiders. 15 of the children with at least 6 months of follow up were included in this study group. After one injection, 9 patients had a complete response with no more urge or diurnal incontinence. There was a statistically significant mean increase in bladder capacity from 167 ml to 271 ml. Three patients had a partial response with a decrease in symptoms, while 3 had no change. One patient had a relapse after 8 months. The three partial responders and the 1 patient who relapsed underwent a second injection which resulted in a full response in the patient who relapsed and one partial responder. The other two had no further response.

Side effects from treatment included temporary urinary retention in 1 girl (lasting 10 days), temporary vesicoureteral reflux in 1 boy, and urinary tract infections in 2 girls.

The authors conclude that BTX is a safe and effective treatment in children with refractory overactive bladder. The optimal clinical effective dose as well as administration technique has yet to be determined. Dr. Jorgensen from Aarhus, Denmark in an editorial comment is cautiously optimistic, but emphasizes the need for long term follow up to determine what effects BTX may have in the developing bladder of children as well as randomized controlled clinical trials.

J Urology 2006; 176:328-331

read other UroToday.com Editors Picks

Pediatric Urology Section

Written by M. Louis Moy, MD, a Contributing Editor with UroToday.

Please log-in or register in order to submit comments.

Powered by AkoComment!