Children with Non-Neurogenic Lower Urinary Tract Dysfunction Require Less Frequent and Number of Botulinum Toxin Injections Than Neurogenic Ones

Objective: To evaluate pediatric patients with lower urinary tract dysfunction (LUTD) who received bladder or external sphincter botulinum toxin A (BTX) injection in terms of effectiveness and permanence.Materials and Methods: We analyzed 80 patients treated with intradetrusor (n=48) n or intrasphincteric (n=32) BTx injection between May 2007 and December 2019. We divided the patients into 2 groups: Neurogenic bladder (NB) and LUTD. Clinical assessment of results was mainly done with Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) and quality of life questionnaires and dryness status. Uroflowmetry with electromyography and video-urodynamic study was performed postoperatively.Results: Mean age and follow-up time were 123.0 +/- 48.3 and 30.1 +/- 5.8 months. For bladder BTx (NB: 18 patients; LUTD: 30 patients), the response rate was 79.1% (n=38). NB patients' response duration was shorter (32 vs 87 weeks) and required subsequent multiple injections more (55% vs 23%) than the LUTD group. For sphincter BTx (NB: 13 patients; LUTD: 19 patients) clinical improvement was found in 75% (n=24) n of the patients. There was no significant difference between the NB and LUTD groups. DVISS and quality of life questionnaires showed substantial decrease in the LUTD groups after bladder (p<0.001) and sphincter (p<0.05) BTx injection. NB patients showed significant dryness status in both BTx-B (pre: 3.2%, post: 82.1%, p<0.05, chi-square test) and BTx-S (pre: 0%, post: 100%, p<0.05, chi-square test) patients postoperatively.Conclusion: This study demonstrated that BTx injection is an effective and safe treatment in pediatric patients with NB and LUTD. With its benefits, this endoscopic treatment should be kept in mind before major constructive surgeries.