title: Applicability of botulinum toxin type A in paediatric neurogenic bladder management.
abstract: The purpose of this article is to provide an overview about the applicability of botulinum toxin type A (BTX-A) in paediatric neurogenic bladder based on the recently published literature combined with hypothetical notes and future perspectives.
  
  
  
  The indications, clinical outcomes, urodynamic outcome parameters and cost-effectiveness are presented from recent publications. Also, alternative routes of application of BTX-A in the bladder are discussed as well as the influence of BTX-A on conservative and invasive treatment.
  
  
  
  Intradetrusor BTX-A injections for neurogenic bladder dysfunction are effective in resolving both urinary incontinence and improving urodynamic parameters in most children with a sustained response at repeated injections. In low-compliance bladders, however, if no response is seen after initial BTX-A injection, repeated injections seem to be unnecessary. Because general anaesthesia is mandatory for BTX-A injections in children, alternative routes of application have been investigated such as intravesical installation, electromotive drug application and liposomal drug delivery; however, no definite results have been found in a paediatric clinical setting.
authors.affiliation: Department of Urology and Pediatric Urology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jeroen R
authors.initials: JR
authors.lastname: Scheepe
authors.forename: Bertil F M
authors.initials: BF
authors.lastname: Blok
authors.forename: Lisette A
authors.initials: LA
authors.lastname: 't Hoen
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D006801:Humans; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive; D014563:Urodynamics
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A