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Non-invasive evaluation of botulinum-A toxin treatment efficacy in children with refractory overactive bladder

  • Urology - Original Paper
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Abstract

Objective

We aimed to evaluate the efficacy and safety of intravesical onabotulinum toxin A (onaBoNTA) injections for the treatment of children diagnosed with refractory overactive bladder (OAB) by using non-invasive methods.

Methods

A total of 31 pediatric patients with a mean age of 10.2 years received intravesical onaBoNTA injection at the dose of 10 U/kg (max: 200 U). Twenty-one patients who failed to respond to the first injection, received second injection 6 months after the first one. The patients were retrospectively evaluated after the 1st and the 2nd injections by means of standardized questionnaire forms and voiding diary records.

Results

In the 6-month follow-up, 10 patients (32.2%) were determined to have full response after the first injection. The number of patients with partial response and no response were found to be 15 (48.4%) and 6 (19.4%), respectively. The mean value of Dysfunctional Voiding and Incontinence Symptom Score (DVISS) of the patients with full response was 8.5 before the injection, which decreased to 1 at 6-month follow-up and to 0.5 at 12-month follow-up (p < 0.001). Twenty-one patients without full response after the first injection received a second injection 6 months after the first one. Full response was achieved in 9 (42.9%) of the 21 patients who had a second injection, but only partial response was achieved in 9 (42.9%). Three (14.3%) of the remaining patients did not respond to the second injection either. 1-year follow-up evaluations revealed that the rates of the full response, partial response, and no response were 61.3, 29, and 9.7%, respectively.

Conclusions

Based on our results, onaBoNTA therapy is an effective and reliable second-line off-label therapy in the management of patients with non-neurogenic OAB that is refractory to medical therapy. Asking the patients/guardians to fill out a standardized questionnaire form before and after the therapy enables easy and non-invasive assessment of the response to the therapy.

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References

  1. Bartoli S, Aguzzi G, Tarricone R (2010) Impact on quality of life of urinary incontinence and overactive bladder: a systematic literature review. Urology 75:491–500

    Article  PubMed  Google Scholar 

  2. Ramsay S, Bolduc S (2017) Overactive bladder in children. Can Urol Assoc J 11(1-Suppl1):74–79. https://doi.org/10.5489/cuaj.4337.

    Article  Google Scholar 

  3. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Walle JV, von Gontard A, Wright A, Yang SS, Neveus T (2016) The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the International Children’s Continence Society. Neurourol Urodyn 35:471–481

    Article  PubMed  Google Scholar 

  4. Kajiwara M, Inoue K, Kato M, Usui A, Kurihara M, Usui T (2006) Nocturnal enuresis and overactive bladder in children: an epidemiological study. Int J Urol 13:36–41

    Article  PubMed  Google Scholar 

  5. Chung JM, Lee SD, Kang DI, Kwon DD, Kim KS, Kim SY, Kim HG, Moon du G, Park KH, Park YH, Pai KS, Suh HJ, Lee JW, Cho WY, Ha TS, Han SW (2009) Prevalence and associated factors of overactive bladder in Korean children 5–13 years old: a nationwide multicenter study. Urology 73:63–67

    Article  PubMed  Google Scholar 

  6. Aubert D, Cencig P, Royer M (1986) Treatment with oxybutynin hydrochloride of urinary incontinence and hyperactive bladder conditions in children. Ann Pediatr 33:629–634

    CAS  Google Scholar 

  7. Humphreys MR, Vandersteen DR, Slezak JM, Hollatz P, Smith CA, Smith JE, Reinberg YE (2006) Preliminary results of sacral neuromodulation in 23 children. J Urol 176:2227–2231

    Article  PubMed  Google Scholar 

  8. Chuang Y-C, Kuo H-C, Chancellor MB (2010) Botulinum toxin for the lower urinary tract. BJU Int 105(8):1046–1058

    Article  PubMed  CAS  Google Scholar 

  9. Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD (1988) Effects of botulinum-A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 139(5):919–922

    Article  PubMed  CAS  Google Scholar 

  10. Schurch B, Stohrer M, Kramer G, Schmid DM, Gaul G, Hauri D (2000) Botilinum A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticolinergic drugs? Preliminary results. J Urol 164(3 Pt 1):692–697

    Article  PubMed  CAS  Google Scholar 

  11. Akbal C, Genc Y, Burgu B, Ozden E, Tekgul S (2005) Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. J Urol 173(3):969–973

    Article  PubMed  Google Scholar 

  12. Starkman JS, Smith CP, Staskin DR (2010) Surgical options for drug-refractory overactive bladder patients. Rev Urol 12(2–3):e97–e110

    PubMed  PubMed Central  Google Scholar 

  13. Dasgupta R, Murphy FL (2009) Botulinum toxin in paediatric urology: a systematic literatüre review. Pediatr Surg Int 25:19–23

    Article  PubMed  Google Scholar 

  14. Greenfield SP, Fera M (1991) The use of intravesical oxybutynin chloride in children with neurogenic bladder. J Urol 146:532–534

    Article  PubMed  CAS  Google Scholar 

  15. Alloussi S, Murtz G, Braun R, Gerhardt U, Heinrich M, Hellmis E, Horn W, Marschall-Kehrel D, Niklas K, Raabe M, Rössler T, Seibt B, Siemer S, Schultz-Lampel D, Walter H, Wiedeking B, Alloussi S, Bock P, Strugala G, Madersbacher H (2010) Efficacy, tolerability and safety of propiverine hydrochloride in comparison to oxybutynin in children with urge incontinence due to overactive bladder: Results of a multicentre observational cohort study. BJU Int 106:550–556

    Article  PubMed  Google Scholar 

  16. Morin F, Blais AS, Nadeau G, Moore K, Genois L, Bolduc S (2017) Dual therapy for refractory overactive bladder in children: a prospective open-label study. J Urol 197(4):1158–1163

    Article  PubMed  Google Scholar 

  17. Gilbert SM, Hensle TW (2005) Metabolic consequences and long term complications of enterocystoplasty in children: a review. J Urol 173:1080–1086

    Article  PubMed  Google Scholar 

  18. Hensle TW, Gilbert SM (2007) A review of metabolic consequences and long term complications of enterocystoplasty in children. Curr Urol Rep 8:157–162

    Article  PubMed  Google Scholar 

  19. Guerra LA, Moher D, Sampson M, Barrowman N, Pike J, Leonard M (2008) Intravesical oxybutynin for children with poorly compliant neurogenic bladder: a systematic review. J Urol 180:1091–1097

    Article  PubMed  CAS  Google Scholar 

  20. Greer T, Abbott J, Breytenbach W, McGuane D, Barker A, Khosa J, Samnakay N (2016) Ten years of experience with intravesical and intrasphincteric onabotulinumtoxinA in children. J Pediatr Urol 12(2):94.e1–94.e6

    Article  CAS  Google Scholar 

  21. Fernandez N, Chua ME, Ming JM, Silangcruz JM, Zu’bi F, Dos Santos J, Lorenzo AJ, Braga LH, Lopes RI (2017) Neurostimulation therapy for non-neurogenic overactive bladder in children: a meta-analysis. Urology 110:201–207

    Article  PubMed  Google Scholar 

  22. Hoebeke P, De Caestecker K, Vande Walle J, Dehoorne J, Raes A, Verleyen P, Van Laecke E (2006) The effect of botulinum-A toxin in incontinent children with therapy resistant overactive detrusor. J Urol 176:328–330

    Article  PubMed  CAS  Google Scholar 

  23. Marte A, Borrelli M, Sabatino MD, Balzo BD, Prezioso M, Pintozzi L, Nino F, Parmeggiani P (2010) Effectiveness of botulinum-A toxin for the treatment of refractory overactive bladder in children. Eur J Pediatr Surg 20:153–157

    Article  PubMed  CAS  Google Scholar 

  24. Blackburn SC, Jones C, Bedoya S, Steinbrecher HA, Malone PS, Griffin SJ (2013) Intravesical botulinum type-A toxin (Dysport®) in the treatment of idiopathic detrusor overactivity in children. J Pediatr Urol 9(6 Pt A):750–753. https://doi.org/10.1016/j.jpurol.2012.08.011

    Article  PubMed  CAS  Google Scholar 

  25. Cox L, Cameron AP (2014) OnabotulinumtoxinA for the treatment of overactive bladder. Res Rep Urol 6:79–89. https://doi.org/10.2147/RRU.S43125

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Sekerci CA, Tanidir Y, Garayev A, Akbal C, Tarcan T, Simsek F (2018) Clinical and urodynamic results of repeated intradetrusor onabotulinum toxin A injections in refractory neurogenic detrusor overactivity: up to 5 injections in a cohort of children with myelodysplasia. Urology 111:168–175

    Article  PubMed  Google Scholar 

  27. Anger JT, Weinberg A, Suttorp MJ, Litwin MS, Shekelle PG (2010) Outcomes of intravesical botulinum toxin for idiopathic overactive bladder symptoms: a systematic review of the literature. J Urol 183(6):2258–2264

    Article  PubMed  PubMed Central  Google Scholar 

  28. Brubaker L, Richter HE, Visco A, Mahajan S, Nygaard I, Braun TM, Barber MD, Menefee S, Schaffer J, Weber AM, Wei J (2008) Refractory idiopathic urge urinary incontinence and botulinum A injection. J Urol 180:217–222

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sahai A, Khan MS, Dasgupta P (2007) Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: results from a single center, randomized, double-blind, placebo controlled trial. J Urol 177:2231–2236

    Article  PubMed  CAS  Google Scholar 

  30. Flynn MK, Amundsen CL, Perevich M, Liu F, Webster GD (2009) Outcome of a randomized, double-blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder. J Urol 181:2608–2615

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Section of Pediatric Urology, Department of Urology, Health Sciences University, Tepecik Education and Research Hospital, 35180, İzmir, Turkey

    Murat Uçar

  2. Section of Pediatric Urology, Department of Pediatric Surgery, Health Sciences University, Van Education and Research Hospital, Van, Turkey

    Ahsen Karagözlü Akgül

  3. Department of Pediatric Surgery, Uludağ University Medical Faculty, 16059, Bursa, Turkey

    Ayşe Parlak

  4. Department of Urology, Health Sciences University, Tepecik Education and Research Hospital, 35180, İzmir, Turkey

    Cem Yücel

  5. Division of Pediatric Urology, Department of Pediatric Surgery, Uludağ University Medical Faculty, 16059, Bursa, Turkey

    Nizamettin Kılıç & Emin Balkan

Authors
  1. Murat Uçar
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  2. Ahsen Karagözlü Akgül
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  3. Ayşe Parlak
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  4. Cem Yücel
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  5. Nizamettin Kılıç
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  6. Emin Balkan
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Correspondence to Murat Uçar.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed on human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the parents of each child prior to all the procedures. Also in this study, all parents were informed about the procedure and off-label status of the BTX-A therapy.

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Uçar, M., Akgül, A.K., Parlak, A. et al. Non-invasive evaluation of botulinum-A toxin treatment efficacy in children with refractory overactive bladder. Int Urol Nephrol 50, 1367–1373 (2018). https://doi.org/10.1007/s11255-018-1926-6

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  • DOI: https://doi.org/10.1007/s11255-018-1926-6

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