Botulinum Toxin in the Treatment of Neurogenic Bladder in Adults and Children

ObjectivesThe effectiveness of focal injections of botulinum toxin type A (BoNTA) in relieving symptoms of urinary incontinence (UI) and reducing raised detrusor pressure associated with the risk of renal complications was evaluated in both adults and children with neurogenic UI.MethodsIn study 1, 59 adults with neurogenic detrusor overactivity (NDO) were randomised to receive either placebo or BoNTA (200 U or 300 U BOTOX®) via 30 intradetrusor injections. In study 2, 24 children with NDO who were at risk of kidney impairment were given injections with BoNTA at 12 U/kg (maximum: 300 U) at approximately 40 sites in the detrusor.ResultsIn study 1, UI episodes decreased by 50% and maximum detrusor pressure (MDP) and maximum bladder capacity (MBC) were significantly improved in both the 200-U and 300-U treatment groups. In study 2, MDP had decreased by 41% at 1 mo and by 22% at 3 mo (and had increased nonsignificantly by 4% at 6 mo). MBC had increased by 35%, 23%, and 36%, respectively, at the same intervals. There was no evidence of drug resistance after repeated injections and BoNTA was well tolerated.ConclusionsBoNTA was effective in reducing UI episodes and improving urodynamic parameters in adults and children with UI due to NDO.