Botulinum toxin A for the treatment of neurogenic bladder in children: a systematic review and meta-analysis.

[PURPOSE] We performed a systematic review and meta-analysis to assess the current evidence on the effectiveness of botulinum toxin A (BTX-A) intradetrusor injections in paediatric NB patients who are resistant to antimuscarinic treatments.

[METHODS] A study was carried out on PubMed, Medline, and Embase with the search terms: ('neurogenic bladder' OR 'myelomeningocele') AND 'toxin' AND ('children' OR 'paediatric'). The PICOS framework guided the search strategy and selection of studies in line with the PRISMA guidelines. Research involving original data that examined BTX-A in paediatric patients with NB was included. Studies were independently chosen and data were extracted by two reviewers.

[RESULTS] Nineteen studies (one randomized controlled trial, six prospective studies, and 12 retrospective studies) that investigated the clinical application of BTX-A injections in children with NB were identified. None of the studies compared BTX-A to a placebo, and most lacked a control group. Results showed that maximal cystometric capacity increased by an average of 97.7 mL (34.1-162% increase) (95% confidence interval [CI] 59.6 to 135.8), while maximal detrusor pressure decreased by 25.2 cm HO (95% CI -39.7 to -10.7). Bladder compliance improved by 5.3 mL/cm HO (95% CI 2.9 to 7.8). After treatment, the average incontinence resolution rate among patients was 73.4%. Urinary tract infections were reported by 77 patients (13.6%).

[CONCLUSIONS] BTX-A administered intradetrusorally enhances cystometric capacity, compliance, and maximum neurogenic detrusor overactivity in paediatric patients suffering from neurogenic bladder. Nonetheless, this conclusion lacks support from studies with a high level of evidence.