Children with neurogenic bladders are at risk of renal compromise through high detrusor pressures. Management aims to provide continence and preserve the upper tracts by increasing capacity and compliance though early clean intermittent catheterisation and anticholinergics. Intradetrusor botulinum toxin has been used in adult neurogenic bladders refractory to anticholinergic treatment. However, as yet, there is little evidence of its use in the paediatric setting. In this study, Naqvi et al. have undertaken a single centre retrospective study (July 2008 – July 2014) of all paediatric patients with a neurogenic bladder treated with abobotulinum toxin A (ABTA) – Dysport®. Thirty patients were included. Anticholinergic therapy had failed in all before ABTA injection (failed to reduce maximum neurogenic overactivity and / or improve compliance). Half of patients received multiple injections. Overall, ABTA significantly increased cystometric capacity and reduced maximum neurogenic overactivity, but did not change compliance. When the authors compared overactive bladders (n=16) to low compliance bladders (n=14), they found that compliance was significantly increased in the low compliance group. Injections were well tolerated. Nine patients (30%) became dry between catheterisations, 16 (53.3%) reported significant improvement and five (16.6%) reported no improvement. The authors present data from a large cohort and demonstrate that intradetrusor ABTA is useful for managing children with neuropathic bladders who have continued problems with detrusor overactivity or compliance despite optimised anticholinergic therapy. A dose of up to 40IU/Kg (maximum dose 1200IU) appears to be safe.
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Reviewed by Neil Featherstone
Urodynamic outcomes in children after single and multiple injections for overactive and low compliance neurogenic bladder treated with abobotulinum toxin A.
CONTRIBUTOR
Neil Featherstone
Cambridge University Hospitals NHS Foundation Trust (Addenbrookes Hospital).
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