Botulinum toxin-A (Botox) intradetrusor injections in children with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review.
OBJECTIVE
Describe and discuss the efficacy and safety of botulinum toxin type A (BTX-A) intradetrusor injections in children with neurogenic detrusor overactivity (NDO) and urinary incontinence or overactive bladder symptoms of neurogenic origin (NOAB).


METHODS
A MEDLINE and EMBASE search for clinical studies involving BTX-A injected into the detrusor of children with NDO or NOAB was performed, prior to data analysis.


RESULTS
A total of six articles evaluating the efficacy and safety of Botox in patients with NDO and incontinence/NOAB were selected. The underlying neurological disease was myelomeningocele in 93% of patients. Most were over 2 years of age. The most common amount of Botox injected was 10-12 U/kg with a maximal dose of 300 U, usually as 30 injections of 10 U/ml in the bladder (excluding the trigone) under cystoscopic guidance and general anaesthesia. Most of the studies reported a significant improvement in clinical (65-87% became completely dry) as well as urodynamic (in most studies mean maximum detrusor pressure was reduced to <40 cm H(2)O and compliance was increased >20 ml/cm H(2)O) variables, without major adverse events.


CONCLUSIONS
Botox injections into the detrusor provide a clinically significant improvement and seem to be very well tolerated in children with NDO and incontinence/NOAB refractory to antimuscarinics.
Gamé
Xavier
X
Hôpital Rangueil, Toulouse, France. xaviergame@hotmail.com
Mouracade
Pascal
P
Chartier-Kastler
Emmanuel
E
Viehweger
Elke
E
Moog
Raphael
R
Amarenco
Gérard
G
Denys
Pierre
P
De Seze
Marianne
M
Haab
François
F
Karsenty
Gilles
G
Kerdraon
Jacques
J
Perrouin-Verbe
Brigitte
B
Ruffion
Alain
A
Soler
Jean-Marc
JM
Saussine
Christian
C
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A