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Intradetrusor onabotulinum-A toxin injections in children with therapy resistant idiopathic detrusor overactivity : a retrospective study

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Abstract
Introduction and objective The use of intravesical onabotulinum-A toxin (BoNT-A) injections in the treatment of idiopathic detrusor overactivity has been widely studied in adults [2-5]. However, in pediatric populations, study groups are small, and results are not yet sufficient to support this treatment as a standard practice. The aim of this study is to determine the effectiveness and safety of this treatment in children with non-neurogenic detrusor overactivity, resistant to conservative therapy. Material and methods We retrospectively evaluated the effect and safety of the intradetrusor injection of 100 Units (U) of BoNT-A in 257 children with therapy-resistant non-neurogenic detrusor overactivity between May 2003 and August 2017. Outcome parameters were the number of daytime incontinence and enuresis episodes per week and bladder capacity (BC). Treatment outcomes were classified into complete response, partial response, or no response. Results The database includes 257 children, of which are 102 girls and 155 boys. Median age of first BoNT-A injection was 8 years (range 4-18 years). Of the patients with enuresis, daytime incontinence or both, a complete response was seen in 50%, 45.7%, and 17%, respectively. BC was significantly higher after the first, second, and third injection of 100 U BoNT-A. We estimated that the mean duration of the effect of an injection with a dose of 100 U is around 12 months. After the first injection, one girl (0.4%) developed urinary retention, which required temporary clean intermittent catheterization (CIC). Seventeen patients (6.6%) developed a urinary tract infection. In three patients (1.2%), postoperative vesicoureteral reflux was seen. Discussion A distinction between the effect on daytime incontinence and enuresis was made. A poorer effect on enuresis in children who suffered from both conditions was observed. Drawbacks of this study are its retrospective design and the lack of anticholinergic treatment standardization before and after BoNT-A injection. Conclusion BoNT-A injection is a potentially effective adjuvant therapy in the treatment of children with therapy-resistant overactive bladder (OAB). Bladder capacity increases significantly after the first, second, and third injections. A better effect on daytime incontinence than on enuresis was seen. Prospective randomized trials with standardization of conservative treatment and symptoms questionnaires are necessary to confirm the beneficial effect of BoNT-A injections on BC and incontinence. [GRAPHICS]
Keywords
Pediatrics, Perinatology, and Child Health, Urology, Botulinum toxin, Intravesical injections, Detrusor overactivity in children, Non-neurogenic detrusor overactivity, BOTULINUM-TOXIN, URINARY-INCONTINENCE, BLADDER

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MLA
Ringoir, Annelies, et al. “Intradetrusor Onabotulinum-A Toxin Injections in Children with Therapy Resistant Idiopathic Detrusor Overactivity : A Retrospective Study.” JOURNAL OF PEDIATRIC UROLOGY, vol. 16, no. 2, 2020, doi:10.1016/j.jpurol.2019.12.013.
APA
Ringoir, A., Dhondt, B., De Bleser, E., Van Laecke, E., Everaert, K., Groen, L. A., … Spinoit, A.-F. (2020). Intradetrusor onabotulinum-A toxin injections in children with therapy resistant idiopathic detrusor overactivity : a retrospective study. JOURNAL OF PEDIATRIC UROLOGY, 16(2). https://doi.org/10.1016/j.jpurol.2019.12.013
Chicago author-date
Ringoir, Annelies, Bert Dhondt, Elise De Bleser, Erik Van Laecke, Karel Everaert, Luitzen Albert Groen, Piet Hoebeke, and Anne-Françoise Spinoit. 2020. “Intradetrusor Onabotulinum-A Toxin Injections in Children with Therapy Resistant Idiopathic Detrusor Overactivity : A Retrospective Study.” JOURNAL OF PEDIATRIC UROLOGY 16 (2). https://doi.org/10.1016/j.jpurol.2019.12.013.
Chicago author-date (all authors)
Ringoir, Annelies, Bert Dhondt, Elise De Bleser, Erik Van Laecke, Karel Everaert, Luitzen Albert Groen, Piet Hoebeke, and Anne-Françoise Spinoit. 2020. “Intradetrusor Onabotulinum-A Toxin Injections in Children with Therapy Resistant Idiopathic Detrusor Overactivity : A Retrospective Study.” JOURNAL OF PEDIATRIC UROLOGY 16 (2). doi:10.1016/j.jpurol.2019.12.013.
Vancouver
1.
Ringoir A, Dhondt B, De Bleser E, Van Laecke E, Everaert K, Groen LA, et al. Intradetrusor onabotulinum-A toxin injections in children with therapy resistant idiopathic detrusor overactivity : a retrospective study. JOURNAL OF PEDIATRIC UROLOGY. 2020;16(2).
IEEE
[1]
A. Ringoir et al., “Intradetrusor onabotulinum-A toxin injections in children with therapy resistant idiopathic detrusor overactivity : a retrospective study,” JOURNAL OF PEDIATRIC UROLOGY, vol. 16, no. 2, 2020.
@article{8640123,
  abstract     = {Introduction and objective

The use of intravesical onabotulinum-A toxin (BoNT-A) injections in the treatment of idiopathic detrusor overactivity has been widely studied in adults [2-5]. However, in pediatric populations, study groups are small, and results are not yet sufficient to support this treatment as a standard practice. The aim of this study is to determine the effectiveness and safety of this treatment in children with non-neurogenic detrusor overactivity, resistant to conservative therapy.

Material and methods

We retrospectively evaluated the effect and safety of the intradetrusor injection of 100 Units (U) of BoNT-A in 257 children with therapy-resistant non-neurogenic detrusor overactivity between May 2003 and August 2017. Outcome parameters were the number of daytime incontinence and enuresis episodes per week and bladder capacity (BC). Treatment outcomes were classified into complete response, partial response, or no response.

Results

The database includes 257 children, of which are 102 girls and 155 boys. Median age of first BoNT-A injection was 8 years (range 4-18 years). Of the patients with enuresis, daytime incontinence or both, a complete response was seen in 50%, 45.7%, and 17%, respectively. BC was significantly higher after the first, second, and third injection of 100 U BoNT-A. We estimated that the mean duration of the effect of an injection with a dose of 100 U is around 12 months. After the first injection, one girl (0.4%) developed urinary retention, which required temporary clean intermittent catheterization (CIC). Seventeen patients (6.6%) developed a urinary tract infection. In three patients (1.2%), postoperative vesicoureteral reflux was seen.

Discussion

A distinction between the effect on daytime incontinence and enuresis was made. A poorer effect on enuresis in children who suffered from both conditions was observed. Drawbacks of this study are its retrospective design and the lack of anticholinergic treatment standardization before and after BoNT-A injection.

Conclusion

BoNT-A injection is a potentially effective adjuvant therapy in the treatment of children with therapy-resistant overactive bladder (OAB). Bladder capacity increases significantly after the first, second, and third injections. A better effect on daytime incontinence than on enuresis was seen. Prospective randomized trials with standardization of conservative treatment and symptoms questionnaires are necessary to confirm the beneficial effect of BoNT-A injections on BC and incontinence.

[GRAPHICS]},
  author       = {Ringoir, Annelies and Dhondt, Bert and De Bleser, Elise and Van Laecke, Erik and Everaert, Karel and Groen, Luitzen Albert and Hoebeke, Piet and Spinoit, Anne-Françoise},
  issn         = {1477-5131},
  journal      = {JOURNAL OF PEDIATRIC UROLOGY},
  keywords     = {Pediatrics,Perinatology,and Child Health,Urology,Botulinum toxin,Intravesical injections,Detrusor overactivity in children,Non-neurogenic detrusor overactivity,BOTULINUM-TOXIN,URINARY-INCONTINENCE,BLADDER},
  language     = {eng},
  number       = {2},
  pages        = {8},
  title        = {Intradetrusor onabotulinum-A toxin injections in children with therapy resistant idiopathic detrusor overactivity : a retrospective study},
  url          = {http://dx.doi.org/10.1016/j.jpurol.2019.12.013},
  volume       = {16},
  year         = {2020},
}

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