Intravesical Botulinum Toxin Injection for Treating Detrusor Overactivity and Poor Compliance in Posterior Urethral Valves-A Preliminary Experience.

Abstract

Purpose: To report our preliminary experience on the use of Botulinum toxin A in boys with posterior urethral valves for treating detrusor overactivity and/or reduced bladder compliance not responsive to medical treatment.

Material and methods: Primary outcome measures studied were change in baseline end fill pressure (pDet), compliance, maximum Detrusor overactivity pressure (DO), fractional bladder capacity (FBC), vesicoureteric reflux (VUR) grade/resolution. Secondary outcome measures were serum creatinine and estimated glomerular filtration rate (eGFR). Low compliance group was defined as rise in baseline pDet > 20 cmH₂O. High pressure DO was defined as maximum pDet > 40 cmH₂0.

Results: A total of 15 children were included in the analysis. The median decrease in end fill pDet in the whole cohort was from 20 cmH₂O (14.5-30) to 16 cmH₂O (10.5-22) (p = 0.065). By analyzing the patients with low compliance, we identified a median decrease in end fill pDet from 32 cmH₂O (26.5-44.5) to 19 cmH₂O (16.5-25.5) (p = 0.028). The median change in compliance for all the boys was from 6 mL/cmH₂O (4.51-7.3) to 12.1 mL/cmH₂O (7.44-17.3) (p < 0.001). The median change in compliance in the low compliance group was from 5.5 mL/cmH₂O (4.42-7.1) to 8.8 mL/cmH₂O (7.39-13.3) (p = 0.018). The median change in fractional bladder capacity for all the boys was from 0.70 (0.55-0.92) to 0.98 (0.79-1.42) (p = 0.061). A complete resolution of DO was observed in 7 out of 11 patients. Complete resolution of VUR was observed in 5 out of 8 renal units.

Conclusion: Botulinum toxin A can be considered in the treatment strategy for reduced bladder compliance and detrusor overactivity in boys with PUV.

Trial registration: 15894.