Efficacy and Safety of Botulinum Toxin A for Treating Bladder Hyperactivity in Children and Adolescents with Neuropathic Bladder Secondary to Myelomeningocele

We verified the efficacy and safety of botulinum toxin A (BTX-A) in treating bladder overactivity in children with neurogenic bladder (NB) secondary to myelomeningocele (MMC). Forty-seven patients (22, females; 25, males; age range, 5–17 years; mean age, 10.7 years) with poorly compliant/overactive neurogenic bladder on clean intermittent catheterization (CIC) and resistance or noncompliant to anticholinergics were injected with 200？IU of BTX-A intradetrusor. All patients experienced a significant 66.45% average increase of leak point volume (Wilcoxon paired rank test = 7.169 e-10) and a significant 118.57% average increase of specific bladder capacity at 20？cm H2O (Wilcoxon paired rank test = 2.466 e-12). Ten patients who presented with concomitant uni/bilateral grade II–IV vesicoureteral reflux were treated at the same time with Deflux. No patient presented with major perioperative or postoperative problems. Twenty-two patients needed a second and 18 a third injection of BTX-A after 6–9 months for the reappearance of symptoms. After a mean follow-up of 5.7 years, 38 out of 47 patients achieved dryness between CICs, and 9 patients improved their incontinence but still need pads. Our conclusion is that BTX-A represents a viable alternative to more invasive procedure in treatment of overactive NB secondary to MMC. 1. Introduction Current treatment of patients with neurogenic bladder (NB) secondary to myelomeningocele (MMC) is mainly based on the clean intermittent catheterization (CIC), and the associated anticholinergic agents, or on surgical procedures on the bladder or bladder neck. In cases where the NB is characterized by overactivity or low compliance, the first safeguard is the use of early anticholinergic drugs, such as oxybutynin, tolterodine, or most recently trospium chloride with the ultimate goal of making the patient dry safeguarding renal function. If anticholinergics and CIC do not provide the desired result, then it is necessary to use more invasive techniques of expansion in order to transform the bladder into a reservoir with high capacity or low pressure [1]. On the basis of recent research, there is an increasingly assertion of the use of botulinum toxin A (BTX-A) in the treatment of NB secondary to MMC as a valid alternative to invasive procedures [2–5]. We present our experience in a selected group of patients in whom the clinical evaluation and urodynamics assumed the need for action to expand their bladder due to the poor response to drugs, and in whom incontinence and the use of pads between the catheterizations strongly