Liu Jialin,Liu Ying,Tang Liangfeng,et al.Evaluations of botulinum toxin injection into detrusor for neurogenic detrusor overactivity in children[J].Journal of Clinical Pediatric Surgery,,21():752-757.[doi:10.3760/cma.j.cn101785-202203025-009]
Evaluations of botulinum toxin injection into detrusor for neurogenic detrusor overactivity in children
- Keywords:
- Urinary Bladder; Neurogenic/DT; Urinary Bladder; Neurogenic/SU; Botulinum Toxins; Type A; Treatment Outcome; Child
- Abstract:
- Objective To evaluate the clinical efficacy of botulinum toxin injection for pediatric neurogenic detrusor overactivity.Methods From April 2020 to June 2021,a retrospective observational self-control study was performed for neurogenic detrusor overactive children receiving an injection of botulinum toxin at Department of Pediatric Urological Surgery of Children’s Hospital of Fudan University.All cases received continuous antibiotic prophylaxis with limited effect.Febrile urinary tract infection,maximal voiding volume at Month 1/3/6 post-injection,bladder wall thickness on ultrasound,maximal bladder capacity,safe bladder capacity and bladder urodynamic compliance at Month 3 post-injection were compared before and after injection.Results There were 1 boy and 10 girls with a mean age of (80.36±43.35) months and a mean weight of (21.86±7.47) kg.Prior to injection,mean clean intermittent catheterization frequency was (5.86±1.60) times per day,maximal bladder capacity (152.73±58.10) mL,rate of febrile urinary tract infection 100% and bladder wall thickness (4.41±1.95) mm.In pre-injection urodynamic tests,maximal bladder capacity was (158.44±57.26) mL,safe bladder capacity (139.78±66.09) mL and bladder compliance (4.37±2.16) mL/cmH2O.After injection,mean clean intermittent catheterization frequency at Month 1 was (6.18±2.31) times per day (P=0.652),Month 3(5.91±2.38) times per day (P=0.948),Month 6(5.68±1.91) times per day (P=0.736),maximal voiding volume at Month 1(206.82±72.05) mL (P=0.004),Month 3(227.28±94.67) mL (P=0.003) and Month 6(227.28±94.67) mL (P=0.024).Febrile urinary tract infection rate at Month 1 was 1(9%)(P<0.001),Month 3 1(9%)(P<0.001) and Month 6 3(27%)(P=0.001).There were marked improvements.And at Month 3,bladder wall thickness was (2.75±0.84) mm (P=0.004),maximal bladder capacity (225.44±94.03) mL (P=0.041),safe bladder capacity (216.11±106.44) mL (P=0.049) and bladder compliance (9.43±5.74) mL/cmH2O (P=0.023).There were marked improvements.No severe side effects were recorded.Conclusion An injection of botulinum toxin has marked effects upon bladder capacity and pressure in bladder and helps reduce febrile urinary infection in neurogenic bladder children.And botulinum toxin injection is indicated for individuals not tolerating anticholinergic agents.
References:
[1] Sripathi V,Mitra A.Management of neurogenic bladder[J].Indian J Pediatr,2017,84(7):545-554.DOI:10.1007/s12098-017-2356-7.
[2] Stein R,Bogaert G,Dogan HS,et al.EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part II operative management[J].Neurourol Urodyn,2020,39(2):498-506.DOI:10.1002/nau.24248.
[3] Cooley LF,Kielb S.A review of botulinum toxin a for the treatment of neurogenic bladder[J].PM R,2019,11(2):192-200.DOI:10.1016/j.pmrj.2018.07.016.
[4] Baldwin MR,Barbieri JT.Association of botulinum neurotoxins with synaptic vesicle protein complexes[J].Toxicon,2009,54(5):570-574.DOI:10.1016/j.toxicon.2009.01.040.
[5] Lightner DJ,Gomelsky A,Souter L,et al.Diagnosis and treatment of overactive bladder (Non-Neurogenic) in adults:AUA/SUFU guideline amendment 2019[J].J Urol,2019,202(3):558-563.DOI:10.1097/JU.0000000000000309.
[6] Sch?fer W,Abrams P,Liao L,et al.Good urodynamic practices:uroflowmetry,filling cystometry,and pressure-flow studies[J].Neurourol Urodyn,2002,21(3):261-274.DOI:10.1002/nau.10066.
[7] Dykstra DD,Sidi AA,Scott AB,et al.Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients[J].J Urol,1988,139(5):919-922.DOI:10.1016/s0022-5347(17)42717-0.
[8] Reitz A,St?hrer M,Kramer G,et al.European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity[J].Eur Urol,2004,45(4):510-515.DOI:10.1016/j.eururo.2003.12.004.
[9] Dyer LL,Franco I.Botulinum Toxin-A therapy in pediatric urology:indications for the neurogenic and non-neurogenic neurogenic bladder[J].Scientific World Journal,2009,9:1300-1305.DOI:10.1100/tsw.2009.146.
[10] Thaker H,Zhang S,Diamond DA,et al.Beyond botulinum neurotoxin A for chemodenervation of the bladder[J].Curr Opin Urol,2021,31(2):140-146.DOI:10.1097/MOU.0000000000000843.
[11] Hascoet J,Manunta A,Brochard C,et al.Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida:A systematic review[J].Neurourol Urodyn,2017,36(3):557-564.DOI:10.1002/nau.23025.
[12] Kaviani A,Khavari R.Disease-specific outcomes of botulinum toxin injections for neurogenic detrusor overactivity[J].Urol Clin North Am,2017,44(3):463-474.DOI:10.1016/j.ucl.2017.04.012.
[13] Rovner E,Dmochowski R,Chapple C,et al.OnabotulinumtoxinA improves urodynamic outcomes in patients with neurogenic detrusor overactivity[J].Neurourol Urodyn,2013,32(8):1109-1115.DOI:10.1002/nau.22376.
[14] ?ekerci?A,I?bilen B,I?man F,et al.Urinary NGF,TGF-β1,TIMP-2 and bladder wall thickness predict neurourological findings in children with myelodysplasia[J].J Urol,2014,191(1):199-205.DOI:10.1016/j.juro.2013.08.025.
[15] Apostolidis A,Dasgupta P,Denys P,et al.Recommendations on the use of botulinum toxin in the treatment of lower urinary tract disorders and pelvic floor dysfunctions:a European consensus report[J].Eur Urol,2009,55(1):100-119.DOI:10.1016/j.eururo.2008.09.009.
[16] Rajkumar GN,Small DR,Mustafa AW,et al.A prospective study to evaluate the safety,tolerability,efficacy and durability of response of intravesical injection of botulinum toxin type A into detrusor muscle in patients with refractory idiopathic detrusor overactivity[J].BJU Int,2005,96(6):848-852.DOI:10.1111/j.1464-410X.2005.05725.x.
[17] 周广伦,孙俊杰,尹鉴淳,等.儿童神经源性膀胱并尿路感染的临床特点及病原菌分析[J].临床小儿外科杂志,2021,20(11):1021-1025.DOI:10.12260/lcxewkzz.2021.11.005. Zhou GL,Sun JJ,Yin JC,et al.Analysis of pathogens and clinical features of neuropathic bladder with urinary tract infection in children[J].J Clin Ped Sur,2021,20(11):1021-1025.DOI:10.12260/lcxewkzz.2021.11.005.
[18] Vigil HR,Hickling DR.Urinary tract infection in the neurogenic bladder[J].Transl Androl Urol,2016,5(1):72-87.DOI:10.3978/j.issn.2223-4683.2016.01.06.
[19] Wu CQ,Franco I.Management of vesicoureteral reflux in neurogenic bladder[J].Investig Clin Urol,2017,58(Suppl 1):S54-S58.DOI:10.4111/icu.2017.58.S1.S54.
Memo
收稿日期:2022-3-10。
基金项目:复旦大学附属儿科医院专病队列项目(2020ZBDL11)神经源性膀胱专病队列
通讯作者:王翔,Email:13501838663@163.com