Safety and efficacy of trigonal BTX-A injections for children with neurological detrusor overactivity secondary to spinal cord injury.

[OBJECTIVE] To evaluate the efficacy and safety of trigonal botulinum toxin A (BTX-A) injections for children with neurological detrusor overactivity (NDO) secondary to spinal cord injury (SCI).

[METHODS] From February 2012 to December 2018, children with NDO secondary to SCI were enrolled. All patients received 200U BTX-A intradetrusor injections including the trigone. Videourodynamic study was performed at baseline and 12 weeks after injection. The primary outcome measures were the presence of vesicoureteral reflux and standardized urodynamic measures. Secondary outcomes included incontinence quality of life questionnaire (I-QoL), voiding volume, urinary incontinence episodes, and complete dryness.

[RESULTS] A total of 33 pediatric inpatients (28 male and 5 female) completed the study. No one developed VUR at week 0 or week 12. At the first instance of NDO, maximum detrusor pressure (PdetmaxFNDO) and NDO duration were reduced by 29.8% and 31.8%, respectively, whereas NDO volume (VFNDO) increased by 50.5%,12 weeks after injection. Mean urinary incontinence episodes were reduced by 31.7%, whereas voiding volume and I-QOL were increased by 52.9% and 23.3%. 3 patients reported mild transient hematuria during the first week after injection.

[CONCLUSIONS] Our results suggest that the use of bladder-trigone-including intradetrusor BTX-A injection does not induce VUR, and is safe and effective in children with NDO secondary to SCI.

[TYPE OF STUDY] A prospective self-controlled trial LEVEL OF EVIDENCE: Level II.