To assess the effectiveness of Intradetrusor injections of botulinum toxin type A (IDBTX-A) in children with spina bifida.
All patients aged under 16 year-old who underwent IDBTX-A between 2002 and 2016 at six institutions were included in a retrospective study. Our primary endpoint was the success rate of IDBTX-A defined as both clinical improvement (no incontinence episodes between clean-intermittent catheterization (CIC), absence of urgency, less than 8 CIC per day)) and urodynamic improvement (resolution of derusor overactivity, normal bladder compliance for age) lasting ≥ 12 weeks. Predictive factors of success were assessed through univariate analysis.
Fifty-three patients with a mean age of 8.5 years were included. All patients were under CIC and 88.7% had received anticholinergics with either poor efficacy or bothersome adverse events The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele (p=0.002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 vs. 54.4 cm H2O; p=0.02). The urodynamic success rate was 34%. Maximum cystometric capacity (p<0.0001) and compliance (p=0.01) significantly improved after the first IDBTX-A and maximum detrusor pressure tended to decrease (p=0.09) except in the subgroup of patients with poor compliance. After a mean follow up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Excluding six patients lost to follow-up, 38.3% of patients were still undergoing botulinum toxin injections at last follow-up.
In this series, despite IBTX-A enabled clinical improvement in 66% patients urodynamic outcomes were poor resulting in a low global success rate (30%).
Urology. 2018 Mar 06 [Epub ahead of print]
Juliette Hascoet, Benoit Peyronnet, Véronique Forin, Maximilien Baron, Grégoire Capon, Thomas Prudhomme, Clément Allenet, Simon Tournier, Charlotte Maurin, Jean-Nicolas Cornu, Ourdia Bouali, Matthieu Peycelon, Alexis Arnaud, Mariette Renaux-Petel, Agnès Liard, Gilles Karsenty, Andrea Manunta, Xavier Game
Department of Urology, University of Rennes, 35000 Rennes, France. Electronic address: ., Department of Urology, University of Rennes, 35000 Rennes, France., Department of Pediatric Physical Therapy and Rehabilitation, Trousseau Hospital, 75012, Paris, France., Department of Urology, University of Rouen, 76000 Rouen, France., Department of Urology, University of Bordeaux, 33000 Bordeaux, France., Department of Urology, University of Toulouse, 31000 Toulouse, France., Department of Urology, University of Marseille, 13000 Marseille, France., Department of Pediatric Surgery, University of Toulouse, 33000 Toulouse, France., Department of Pediatric Surgery, Trousseau Hospital, 75012 Paris, France., Department of Pediatric Surgery, University of Rennes, 35000 Rennes, France., Department of Pediatric Surgery, University of Rouen, 76000 Rouen, France.