Can inter-sphincteric and pelvic floor botulinum toxin type A injections enhance clinical outcomes in pediatric patients with non-neurogenic dysfunctional voiding?

[PURPOSE] To evaluate the effectiveness of external urethral sphincter (EUS) and perineal body BTX-A injections on uroflowmetric factors as well as severity of dysfunctional voiding.

[METHODS] In a prospective cohort study, patients diagnosed with refractory non-neurogenic voiding dysfunction were included in this study. All cases were evaluated pre-operatively by ultrasonography, uroflowmetric study and electromyography (EMG). Voiding cystourethrography or direct radionuclide cystography and other diagnostic modalities were performed if indicated. Using a rigid pediatric endoscope, the urethra and bladder evaluated for underlying concurrent anomalies. BTX-A injection of the perineal body and EUS, was performed transperineally or/and endoscopically. The uroflowmetric parameters and dysfunctional voiding scoring system (DVSS) were evaluated as therapeutic outcomes. Post-operative voiding satisfaction was assessed using a 7-point Likert-type scale with higher response values reflecting greater symptom improvement.

[RESULTS] The study demonstrated significant improvements in DVSS and uroflowmetric parameters in the included cases after a mean follow-up period of 16.14 ± 6.14 months. Among the 82 included cases, 12 patients experienced transient post-injection urinary incontinence, which resolved on average within 0.32 ± 0.91 weeks post-injection. Post-operative voiding satisfaction demonstrated a median score of 7 with an inter-quartile range of 1.25. Several limitations can be addressed including single center cohort study and absence of control group.

[CONCLUSION] This study demonstrates the therapeutic potential of BTX-A injection in refractory non-neurogenic dysfunctional voiding pediatric cases. In addition, the BTX-A injection depicted promising improvements of post-operative voiding satisfaction.