title: Effectiveness of botulinum-A toxin for the treatment of refractory overactive bladder in children.
abstract: OBJECTIVE
  We describe our experience with botulinum-A toxin (BTX-A) in children presenting idiopathic overactive bladder (OAB) refractory to anticholinergic drugs.
  
  
  METHODS
  21 patients, aged 8-12 years, were treated over a 3-year period. BTX-A was administered at a dosage of 12.5 UI /kg body weight, without exceeding 200 UI, at 20 detrusor sites. To ensure a stable solution, each 100 UI of botulinum toxin was diluted with 5 cc saline solution just prior to performing the cystoscopy.
  
  
  RESULTS
  No patient presented with severe systemic complications or urinary retention after injection therapy; 6 patients presented with slight hematuria for 2-3 days. The clinical results were as follows. At 6 months, 8/21 patients (38%) showed full response, 12/21 (57%) had a partial response after a 2 (nd) injection, and 1/21 (4.7%) showed no response after a 2 (nd) injection. At 12 months, 16 patients (76%) had a full response, 4 (19%) showed a partial response after a 3 (rd) injection, and 1 patient (4.7%) still had no response. At 18 months, 18 patients (85%) showed a full response, 2 patients (9.5%) had a partial response, 1 patient (4.7%) had no response. At the end of this study, 8/21 patients (38%) were symptom-free, after only one botulinum detrusor injection, 13/21 patients (61.9%) received a second botulinum injection because of recurrence of urinary incontinence 6-7 months after the initial treatment, and 4/21 patients (19%) received a third injection 12-14 months after the initial treatment, of whom 2 had a full response and 2 had a partial response. Patient no. 20 refused any further botulinum treatment after the 2 (nd) unsuccessful injection series.
  
  
  CONCLUSIONS
  Intravesical BTX-A injection appears to be safe and useful in children presenting with idiopathic overactive drug-resistant bladder.
authors.affiliation: Pediatric Surgery-Second University of Naples, Pediatrics, Naples, Italy. antonio.marte@unina2.it
authors.forename: A
authors.initials: A
authors.lastname: Marte
authors.forename: M
authors.initials: M
authors.lastname: Borrelli
authors.forename: M D
authors.initials: MD
authors.lastname: Sabatino
authors.forename: B D
authors.initials: BD
authors.lastname: Balzo
authors.forename: M
authors.initials: M
authors.lastname: Prezioso
authors.forename: L
authors.initials: L
authors.lastname: Pintozzi
authors.forename: F
authors.initials: F
authors.lastname: Nino
authors.forename: P
authors.initials: P
authors.lastname: Parmeggiani
mesh_terms: D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A