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Intradetrusor Injections of Botulinum Toxin Type A in Children With Spina Bifida: A Multicenter Study

Juliette Hascoet 1 Benoit Peyronnet 2 Veronique Forin 3 Maximilien Baron 4 Grégoire Capon 5 Thomas Prudhomme 6 Clément Allenet 5 Simon Tournier 3 Charlotte Maurin 7 Jean-Nicolas Cornu 8, 9, 10, 11 Ourdia Bouali 12 Matthieu Peycelon 13 Alexis Arnaud 14 Mariette Renaux-Petel 15 Agnès Liard 15 Gilles Karsenty 16 Andrea Manunta 17 Xavier Gamé 6
1 UNIV-RENNES - Université de Rennes
2 Service d'urologie
3 Service de réhabilitation pédiatrique [CHU Trousseau]
4 Service d'urologie [Rouen]
5 service d'urologie [CHU Bordeaux]
6 CHU Toulouse [Toulouse]
7 CHU Marseille
8 Service d'urologie [CHU Tenon]
9 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
10 IRIB - Institute for Research and Innovation in Biomedicine
11 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
12 Hôpital Purpan [Toulouse]
13 CHU Trousseau [APHP]
14 Service de chirurgie pédiatrique [Rennes]
15 CHU Rouen
16 Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM]
17 CHU Pontchaillou [Rennes]
Abstract : OBJECTIVE: To assess the effectiveness of intradetrusor injections of botulinum toxin type A (IDBTX-A) in children with spina bifida. METHODS: All patients aged less than 16 years old who underwent IDBTX-A between 2002 and 2016 at 6 institutions were included in a retrospective study. Our primary endpoint was the success rate of IDBTX-A defined as both clinical improvement (no incontinence episodes between clean intermittent catheterizations [CICs], absence of urgency, and less than 8 CICs per day) and urodynamic improvement (resolution of detrusor overactivity and normal bladder compliance for age) lasting ≥12 weeks. Predictive factors of success were assessed through univariate analysis. RESULTS: Fifty-three patients with a mean age of 8.5 years were included. All patients were under CIC and 88.7% had received anticholinergics with either poor efficacy or bothersome adverse events. The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele (P = .002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 cm H2O vs 54.4 cm H2O, P = .02). The urodynamic success rate was 34%. Maximum cystometric capacity (P <.0001) and compliance (P = .01) significantly improved after the first IDBTX-A and maximum detrusor pressure tended to decrease (P = .09) except in the subgroup of patients with poor compliance. After a mean follow-up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Excluding 6 patients who were lost to follow-up, 38.3% of patients were still undergoing botulinum toxin injections at last follow-up. CONCLUSION: In this series, despite the fact that IDBTX-A enabled clinical improvement in 66% patients, urodynamic outcomes were poor resulting in a low global success rate (30%).
Keywords : Botulinum Toxins Type A/administration & dosage* Injections Intramuscular Intermittent Urethral Catheterization/statistics & numerical data Urinary Bladder/innervation Urinary Bladder Neurogenic/etiology
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https://hal-normandie-univ.archives-ouvertes.fr/hal-02402881
Contributor : Sabine Douville <>
Submitted on : Tuesday, December 10, 2019 - 4:16:22 PM
Last modification on : Wednesday, August 19, 2020 - 12:08:17 PM

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COMUE-NORMANDIE | UNIROUEN | ADEN | UNIV-RENNES1 | UNIV-RENNES | UNIV-AMU | CNRS

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Juliette Hascoet, Benoit Peyronnet, Veronique Forin, Maximilien Baron, Grégoire Capon, et al.. Intradetrusor Injections of Botulinum Toxin Type A in Children With Spina Bifida: A Multicenter Study. Urology, Elsevier, 2018, 116, pp.161-167. ⟨10.1016/j.urology.2018.02.033⟩. ⟨hal-02402881⟩

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