Ten years of experience with intravesical and intrasphincteric onabotulinumtoxinA in children

Greer, Timothy J; Abbott, Jeff; Breytenbach, Wynand J. J.; McGuane, D.; Barker, Andrew; Khosa, Japinder; Samnakay, Naeem

doi:10.1016/j.jpurol.2015.06.019

Cited by 46 publications

(21 citation statements)

References 21 publications

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“…56,58 Thus, children and families must be willing to perform clean intermittent catheterization (CIC) before agreeing to the procedure. Systemic absorption can lead to more severe side effects, including respiratory depression requiring mechanical ventilation.…”

Section: Intradetrusor Injections Of Botulinum Toxinmentioning

confidence: 99%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children's development. From the patient's perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures.Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.

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Section: Intradetrusor Injections Of Botulinum Toxinmentioning

confidence: 99%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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“…Elevated post-void residual were seen in patients voiding spontaneously. In a study of Greer, three children (2.8%) developed urinary retention after intravesical BTX injection [81]. In another study, post procedure urinary retention requiring catheterization was only 1.6% [85].…”

Section: Side Effectsmentioning

confidence: 96%

“…In some studies, the procedure was repeated more than ten times with the same effect as the first injection [37, 38••, 39, 47, 57, 58•, 65•, 72]. In some studies, Botox remained effective after up to 11 injections [81].…”

Section: Repeated Injectionsmentioning

confidence: 99%

“…Fifteen out of 16 (93.75%) refluxing ureters were completely resolved by this kind of treatment [82•]. BTX treatment may confer longterm bladder and upper tract protection in the neurogenic patient group, treating new-onset hydronephrosis secondary to the neurogenic bladder [81]. Furthermore, BTX treatment was found to be a cost-effective therapy for OB and should be further explored as a first line option in the treatment paradigm [83••].…”

Section: Influence On Upper Urinary Tractmentioning

confidence: 99%

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The Current Role of Botox in a Pediatric Neurogenic Bladder Condition

Kroll

2019

Curr Bladder Dysfunct Rep

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Purpose of Review The neurogenic bladder is a medical term that describes a variety of bladder and sphincter dysfunctions. There are two major dangerous functional problems in a child with neurogenic bladder: high intravesical pressure in the storage phase and high pressure during urination. Two basic goals for urologic treatment in those children are protection of urinary tract from complications and improvement of continence in older children. This review focuses on the current role of botulinum toxin treatment in children with neurogenic bladder. Recent Findings At the beginning, treatment in this group of children is conservative. Oral anticholinergic therapy is aimed at decreasing bladder pressures during the storage phase. Clean intermittent catheterization enables bladder emptying if voiding is insufficient. Nevertheless, in a number of children such an approach fails, in some patients, troublesome side effects occur. In cases when standard therapy provides no improvement or if complications develop on the proper conservative treatment, surgical procedures are suggested. Operations are aimed at the surgical enlargement of bladder capacity. There are some reports on the efficacy of cystoscopic detrusor botulinum toxin injections in the treatment of neurogenic bladder in children. Summary Cystoscopic administration of botulinum toxin represents an alternative method of treatment to surgery for children with neurogenic bladder and could be considered an alternative to oral anticholinergic therapy.

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“…Costs are given in Canadian dollars, using Canadian public health system, and based on our institutional experience and available literature. The costs do not include physicians time, follow up appointments, ongoing costs into adulthood (30,31), nor the time required daily for personal care (>1 h/day). The costs indicated here include the initial surgery/set up and supplies for 3-5 years.…”

Section: Cost Analysismentioning

confidence: 99%

Assessment of Needs in Children Suffering From Refractory Non-neurogenic Urinary and Fecal Incontinence and Their Caregivers' Needs and Attitudes Toward Alternative Therapies (SNM, TENS)

et al. 2020

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Background: Non-neurogenic urinary and fecal incontinence (UI, FI) affects approximately 6% of North American children with 1% of cases becoming refractory (nonresponsive to standard therapies). Incontinence has major potential long-term physiological and psychological implications for patients and their families. While Sacral Neuromodulation (SNM) and Transcutaneous Nerve Stimulation (TENS) are alternative therapies available for the treatment of refractory UI/FI, these are not approved for use in children in Canada. The present study assessed participants' perception of current treatments, incontinence burden, and attitudes toward novel therapies in a single pediatric institution. Methods: Multiple validated questionnaires including Dysfunctional Voiding Scoring System (DVSS), Bristol Stool Chart (BSC), Pediatric Incontinence measurement (PinQ), and Time-Driven Activity Based Costing were used to perform a needs assessment for patients with non-neurogenic refractory incontinence, and to determine patients' and caregivers' attitudes toward alternative therapies. Results: 75% of patients and 89% of caregivers reported a moderate to severe impact of incontinence on QoL with diminished social interactions among the primary concerns. Caregivers were frustrated with current treatments and were open to trying alternative therapies (SNM and TENS), which, at least in the case of SNM, seems to be less expensive, possibly less burdensome and more effective than current surgical options. Dos Santos et al. Pediatric Incontinence Burden Conclusion: Pediatric refractory UI/FI has a large impact on patients' and caregivers' QoL and alternative therapies with the potential to improve QoL of patients and caregivers should be further investigated as a substitute for surgery.

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Ten years of experience with intravesical and intrasphincteric onabotulinumtoxinA in children

Cited by 46 publications

References 21 publications

Overactive bladder in children

Overactive bladder in children

The Current Role of Botox in a Pediatric Neurogenic Bladder Condition

Assessment of Needs in Children Suffering From Refractory Non-neurogenic Urinary and Fecal Incontinence and Their Caregivers' Needs and Attitudes Toward Alternative Therapies (SNM, TENS)

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