Success Rate and Predicting Factors for Repeated High‐Dose Intradetrusor Dysport Injections in Children With Neurogenic Bladder: A Retrospective Study

Abstract

ObjectivesEvaluating the effectiveness and safety of repeated high‐dose intradetrusor abobotulinumtoxin A (Dysport®) injections for the treatment of pediatric neurogenic bladders refractory to medications.DesignRetrospective interventional study.ParticipantsThe cohort included 37 children (22 boys and 15 girls) of median age 9.2 years. Inclusion criteria were diagnosis of neurogenic bladder and failure to respond to medical treatment. Exclusion criteria were augmented bladder, insufficient data, and interval of > 11 months between video‐urodynamic study and Dysport injection.InterventionsAll participants were treated with an intra‐detrusor injection of Dysport 30 IU/kg (up to 1000 IU) under general anesthesia. Repeated (second and third) injections were scheduled (6–12 months) in patients who demonstrated an improvement in cystometric parameters. All participants underwent video urodynamic testing before onset of treatment and 4–5 months after subsequent injection.Main Outcome MeasuresSuccess of treatment was defined as a decrease in end filling pressure (EFP) to < 40 cm H2O and/or a 20% increase in maximal cystometric capacity (MCC). These parameters along with initial bladder features were evaluated for ability to predict treatment success.ResultsNo side effects of Dysport were observed or reported. The overall success rate was 62%. MCC increased by a median of 30% (IQR 200–300, p < 0.001), 37% (IQR 197–310, p = 0.001) and 45% (IQR 245–300, p = 0.025) after the first, second and third injections, respectively. Median EFP decreased from 45 cm H2O to 34 cm H2O (IQR 20–45, p = 0.029), 23 cm H2O (IQR 20–37, p = 0.004), and 20 cm H2O (IQR 12–32, p = 0.049) after the first, second, and third injections, respectively. No predicting factor of success of treatment were found; However, three of five cases of “end stage” bladder showed improvement.ConclusionsHigh‐dose Dysport injection is safe and effective for the treatment of neurogenic bladder. Studies with larger cohort and a control group would further elucidate which bladders would benefit most. At present, we recommend treating also bladders with “end stage” features with botulinum toxin before considering augmentation.