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TEN YEARS OF EXPERIENCE WITH INTRAVESICAL AND INTRASPINCTERIC
BOTULINUM TYPE-A TOXIN IN CHILDREN
Timothy GREER, James ABBOTT, Wynand BREYTENBACH, Dayne MCGUANE, Andrew BARKER, Japinder KHOSA and
Naeem SAMNAKAY
Princess Margaret Hospital, Paediatric Surgery, Perth, AUSTRALIA
PURPOSE
We reviewed our 10 year experience with both intravesical and intrasphincteric botulinum toxin (Botox) injections in
children to assess long term therapeutic efficacy and duration of response after multiple injections.
MATERIAL AND METHODS
Data was reviewed on 53 children, aged between 1 – 18 years at time of first injection, who had 134 injections (106
intravesical, 23 intrasphincteric and 5 combined) between January 2004 and December 2013 at a single paediatric
tertiary hospital. Follow-up occurred 3 months post procedure, and then 3-6 monthly.
RESULTS
Median time until return of symptoms remained stable (ranging from 5-10 months) for children undergoing Botox for
detrusor overactivity (DO) up to a seventh injection. Two patients had ongoing response to Botox for a tenth and
eleventh injection respectively. 45% of patients receiving intrasphincteric Botox for chronic dysfunctional voiding or
detrusor sphincter dyssynergia had resolution of their symptoms with no recurrence. In patients who had symptom
recurrence this occurred sooner than in DO (median 4 months). Symptom resolution was seen in patients undergoing
Botox for novel indications including: new onset hydronephrosis, trigonal hypersensitivity and autonomic dysreflexia. 13
of 134 Botox injections (9.7%) had a culture positive urinary tract infection (UTI) in the two weeks following injection, of
whom all had a history of prior UTIs and three patients (2.8%) developed urinary retention.
CONCLUSIONS
This retrospective study demonstrates that intravesical Botox can remain effective in children up to an eleventh
injection. It is one of the very few longer term follow-up studies in children presented to date. Further study is required
into the role for Botox in trigonal hypersensitivity, new onset hydronephrosis and autonomic dysreflexia.