Clinical outcomes of non‐surgical management of detrusor leak point pressures above 40 cm water in adults with congenital neurogenic bladder

Abstract

A non-surgical protocol for ACU patients with NGB and dLPP/PMDP > 40, utilizing CIC, anticholinergics, and BTX is safe and effective when coupled with coordinated care and close follow-up.

Efficacy and safety of intradetrusor onabotulinumtoxinA injection for managing paediatric non-neurogenic overactive bladder: A prospective case-series study

“…Consistent with the reported 12-month success rates and effectiveness of IDB injection, Ladi-Seyedian et al [19] reported 1-, 2-, 3-, 5-and 6-year success rates of 75%, 45.5%, 37.5%, 33% and 29.1% in patients with UI due to neuropathic detrusor overactivity secondary to myelomeningocoele by the use of intravesical electromotive botulinum toxin type A administration. Whilst, Lane et al [20] documented that non-surgical protocol for patients with neurogenic bladders and detrusor leak-point pressures >40 cmH 2 O, including IDB injection in conjunction with anticholinergics is safe and effective, with a 3-year success rate of 85% In the present study, all patients received IDB injection of 100 U and the procedure resulted in no postoperative problems and this could be attributed to the small injected dose that minimised drug-induced side-effects without compromising the outcome. Also, the injection technique spared the trigone and sphincter to avoid postoperative outflow obstruction, and lastly, proper preoperative eradication of UTI and use of postoperative urinary antiseptics and broad-spectrum antibiotics prevented the possibility of postoperative infectious complications.…”

The endoscopic Botulinum toxin-A injections in equally efficient in the treatment of neurogenic bladder dysfunctions in children in different age groups. Single centre experience after more than 550 procedures.

“…Unfortunately the anticholinergic therapy is introduced as off-label in younger children. [6,[7][8][9][10][11][12].…”

“…At present, bladder augmentation represents the most effective way of surgical correction of the urinary bladder's functional parameters, leading to its increased capacity and decreased intravesical pressure. [12][13][14][15] In younger children the operative cystostomy provides an effective way to decrease intravesical pressures. [16,17] In the last years some reports have been published on the favourable results of Botulinum-A toxin (BTX) administration in patients with a low capacity, high pressure neurogenic bladder.…”

“…Conservative management with clean intermittent bladder catheterization (CIC) and oral anticholinergic pharmacotherapy represents the golden standard in the treatment of children with overactive neurogenic bladder [6,7,12,13]. CIC is a treatment of choice in children with neurogenic bladder and lack of urethra sensation if voiding is ineffective [22,23].…”

“…Conservative treatment prevents complications in the majority of patients. Anticholinergic drugs decrease detrusor muscle contractility leading to decrease of intravesical pressures and increase of functional bladder capacity expressed by elevated volumes of catheterized urine and extended period of dryness between catheterizations [ 7,9,10,12,13]. Oxybutinin (Ditropan, Driptane), solifenacin (Vesicare), tolterodin (Detrusitol, Uroflow), triospiumchloride (Spasmex, Regurin), propiweryn (Detrunorm, Mictonorm), darifenacin (Emselex) or the latest on the market betmigron (Betmiga) were described to be effective both in increasing bladder volume with subsequent decreasing intravesical pressure and improvement in urine continence.…”