Repeated Botulinum-A Toxin Injection in the Treatment of Neuropathic Bladder Dysfunction and Poor Bladder Compliance in Children With Myelomeningocele

Aims: To evaluate the efficacy of intradetrusor injection of Botulinum-A toxin (BoNT/A) in children with neuropathic bladder dysfunction and poor bladder compliance, due to meningomyelocele. Methods: We retrospectively reviewed the charts of 11 children (mean age 6.7 +/- 5.3 years) with neuropathic bladder and poor bladder compliance (mean 7 ml/cmH(2)O) treated with intradetrusor injection of BoNT/A. After urodynamic evaluation a standardized injection was performed. The authors describe their results in 11 children after the first (5x) or repeated (6x) BoNT/A injections. Re-evaluation was performed 3 and 12 months after each injection. Results: Three months after injection detrusor pressure decreased by 17% and bladder capacity increased by 33%. In all but 1 patient bladder compliance stayed poor. Twelve months after treatment patients still had an effect but the values were already reverting towards preoperative levels. With repeated injections we achieved a similar effect on capacity and detrusor pressure as after the first injection. Overall, bladder compliance normalized (>20 cmH(2)O) in only 1 patient. Conclusions: The results confirmed the positive temporary effect of BoNT/A on detrusor pressure and bladder capacity in children with myelomeningocele, even after repeated injections. Nevertheless, bladder compliance stayed severely pathological. Whether an earlier treatment may prevent poor bladder compliance is a yet unanswered question. Neurourol. Urodynam. 30:1546-1549, 2011. (C) 2011 Wiley Periodicals, Inc.