title: Botulinum toxin injections in the management of non-neurogenic overactive bladders in children.
abstract: BACKGROUND
  Non-neurogenic detrusor overactivity in children leads to varying degrees of functional impairments (urinary urgency, pollakiuria, urge incontinence, nocturia). Botulinum toxin has shown its effectiveness in the management of detrusor overactivity in neurological patients.
  
  
  OBJECTIVE
  To evaluate the relevance of intravesical Botulinum toxin injections for the treatment of non-neurogenic overactive bladders in children. These pediatric patients were resistant to all the usual therapeutics (e.g. bladder/bowel rehabilitation, anticholinergic drugs, management of diet/hygiene habits and constipation, percutaneous posterior tibial nerve stimulation).
  
  
  METHODS
  8 children (mean age: 12.5years), 5 girls, 3 boys with daytime and/or nighttime incontinence and non-neurogenic detrusor overactivity validated by urodynamic testing. Urodynamic testing was conducted before the injections as well as 6weeks and 1year post injections. We used Dysport® 8 Speywood Units/kg injected via cystoscopy into 25 different sites.
  
  
  RESULTS
  We noted improvements without any complaints during bladder voiding for all patients, in 6 patients the overactivity disappeared after 1 injection. Compliance was improved early-on in half the cases and at 1year for all cases (from 12% to 61%, p=0.01). Noninhibited contractions decreased constantly in both frequency and intensity. Clinical symptoms improved: mean of 7.75 daytime urinary incontinence episodes (IE) per week before the injection vs. 3 after the procedure (p=0.04). For nighttime IE the improvement was even more noticeable with 7.38 nighttime IE episodes per week before the injection vs. 2.06 after the procedure (p=0,02).
  
  
  CONCLUSIONS
  Intradetrusor Botulinum toxin injections are a potential therapeutic option for the management of non-neurogenic detrusor overactivity in children resistant to the usual treatments.
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France. Electronic address: bertrandpriscilla@yahoo.fr.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Léon
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Jolly
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Binet
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Fiquet
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Vilette
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Francis
authors.initials: F
authors.lastname: Lefebvre
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Marie-Agnès
authors.initials: MA
authors.lastname: Bouché-Pillon-Persyn
authors.affiliation: Pediatric Surgery Department, American Hospital, CHU de Reims, France.
authors.forename: Marie-Laurence
authors.initials: ML
authors.lastname: Poli-Mérol
mesh_terms: D000283:Administration, Intravesical; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014563:Urodynamics
chemical_list: D009466:Neuromuscular Blocking Agents; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA
keywords: Botulinum toxin A; Children; Idiopathic over active bladder