Abstract General Information

Title

EARLY ADMINISTRATION OF BOTULINUM TOXIN IN CHILDREN WITH NEUROGENIC DETRUSOR OVERACTIVITY: A SINGLE CENTER EXPERIENCE IN CHILDREN 5 AND UNDER

Introduction and objective

Botulinum toxin A is a second line therapy for children with neurogenic detrusor overactivity (NDO) as young as age 5. Less is known about the effects of botulinum toxin on NDO and bladder compliance (BC) in younger children. We hypothesized that children ages 5 and under would have a greater improvement in BC and resolution of NDO compared with older children.

Method

We performed an IRB approved retrospective review of all patients who underwent intravesical botulinum toxin injection at our institution from 2013 until 2020. Data collected included demographics, urodynamics parameters, and clinical evaluations before and after the first injection and after the most recent injection. Primary outcomes were resolution of NDO and improvement in BC based on Detrusor Leak Point Pressure or End Fill Pressure if no leak was recorded. Patients with insufficient data were excluded. A McNamar’s test was used to examine BC changes over time. Regression tree analysis was used to examine predictive factors of improvement in compliance.

Results

Sixty-one patients were identified (35 males (57%); median age at first injection 12.5 years). Both age groups (5 years and under and greater than 5 years) demonstrated significant improvement in BC after first and most recent injection. Multivariable modeling demonstrated age 5 or less as the strongest predictor for improved BC after most recent botulinum toxin A injection.

Conclusion

Early utilization of botulinum toxin A in patients with neurogenic bladder is associated with greater improvement in long term BC compared to older patients. Further studies are needed to verify this finding in a larger cohort. Future studies may identify if there is a difference in progression to bladder augmentation in this cohort compared to older children.