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Objective <p>To evaluate the long-term efficacy, continence outcomes, and videourodynamic changes associated with protocol-driven intra-detrusor botulinum toxin A injections (BTA) in children and adolescents with neurogenic bladder.</p> Patients and methods <p>We retrospectively reviewed all patients with neurogenic bladder who underwent BTA between 2011 and 2024 at a large referral center. Data collected included demographics, continence status, and VUDS parameters (capacity, compliance, and detrusor overactivity) pre- and post-injection.</p> Results <p>Among 120 patients (63 male), the most common diagnosis was myelomeningocele (n = 88, 73.3%). The median age at first injection was 10.1&#xa0;years (IQR 8.6). Patients received a median of three injections and were followed for a median of 4.9&#xa0;years (IQR 6.9) after the first BTA injection. The median overall institutional follow-up from diagnosis was 15&#xa0;years (IQR 6.8). Of the 107 patients with available symptom data, 96 (89.7%) reported improved continence. Among these, 37 (34.6%) achieved complete resolution and discontinued oral medications, while 49 (45.8%) required ongoing oral agents to maintain continence. An additional 10 patients (9.3%) reported partial improvement with persistent leakage despite BTA and oral therapy but chose to continue injections. A small subset experienced no (<i>n</i> = 5, 4.7%) or diminishing (<i>n</i> = 6, 5.6%) benefit over time. Bladder capacity increased by 27% (<i>p</i> &lt; 0.01), and both compliance and detrusor overactivity significantly improved post-injections, which were typically repeated every 3–6&#xa0;months. Reported complications were mild and infrequent, including urinary tract infections (11%), constipation (2%), and hematuria (3%).</p> Conclusions <p>BTA injections are a safe and effective treatment option for most pediatric and adolescent neurogenic bladder patients who would otherwise be considered candidates for augmentation cystoplasty. Repeated injections appear to provide sustained improvement in continence and bladder dynamics, supporting their role as a minimally invasive strategy for long-term bladder management in this population.</p>

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Protocol-driven botulinum toxin injections for pediatric neurogenic bladder: long-term continence and bladder outcomes supporting its role as a minimally invasive alternative to augmentation cystoplasty

  • 期刊论文

  • 发表日期：

    2026年6月19日

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  • Kay Chua Rivera,
  • Mandy Rickard,
  • Ihtisham Ahmad,
  • Zwetlana Rajesh,
  • Abby Varghese,
  • Lisa Wang,
  • Michael Erlano Chua,
  • Armando J. Lorenzo,
  • Joana Dos Santos

摘要

Objective

To evaluate the long-term efficacy, continence outcomes, and videourodynamic changes associated with protocol-driven intra-detrusor botulinum toxin A injections (BTA) in children and adolescents with neurogenic bladder.

Patients and methods

We retrospectively reviewed all patients with neurogenic bladder who underwent BTA between 2011 and 2024 at a large referral center. Data collected included demographics, continence status, and VUDS parameters (capacity, compliance, and detrusor overactivity) pre- and post-injection.

Results

Among 120 patients (63 male), the most common diagnosis was myelomeningocele (n = 88, 73.3%). The median age at first injection was 10.1 years (IQR 8.6). Patients received a median of three injections and were followed for a median of 4.9 years (IQR 6.9) after the first BTA injection. The median overall institutional follow-up from diagnosis was 15 years (IQR 6.8). Of the 107 patients with available symptom data, 96 (89.7%) reported improved continence. Among these, 37 (34.6%) achieved complete resolution and discontinued oral medications, while 49 (45.8%) required ongoing oral agents to maintain continence. An additional 10 patients (9.3%) reported partial improvement with persistent leakage despite BTA and oral therapy but chose to continue injections. A small subset experienced no (n = 5, 4.7%) or diminishing (n = 6, 5.6%) benefit over time. Bladder capacity increased by 27% (p < 0.01), and both compliance and detrusor overactivity significantly improved post-injections, which were typically repeated every 3–6 months. Reported complications were mild and infrequent, including urinary tract infections (11%), constipation (2%), and hematuria (3%).

Conclusions

BTA injections are a safe and effective treatment option for most pediatric and adolescent neurogenic bladder patients who would otherwise be considered candidates for augmentation cystoplasty. Repeated injections appear to provide sustained improvement in continence and bladder dynamics, supporting their role as a minimally invasive strategy for long-term bladder management in this population.