INTRODUCTION AND OBJECTIVES: We studied the efficacy of Botulinum Toxin A (BTX-A) detrusor injection in children with acquired central or spinal lesions. The aims were to protect the kidney by decreasing detrusor pressure and to improve comfort.

METHODS: Seven patients aged 8 to 18 years (mean 13,3) with neurogenic bladders were included in a prospective study from 2005. Etiology was: trauma in three cases, central origin in two, and spinal surgery sequel in two. They all emptied their bladder with CIC (finally, four children through a Mitrofanoff conduit). All were wet between catheterisations and four presented urinary tract infections (UTI) despite anticholinergic therapy. All had detrusor hyperreflexia ( more than 40 cm H2O) with low maximal bladder capacity (68% +/- 32,8 of theoretical value). Using cystoscopy we injected BTX-A (12UI/Kg, max: 300UI) transmurally into the detrusor muscle at 30 (and finally 15) sites sparing the trigone. Procedure was sometimes done without sedation. New injection was decided at the time of urinary leakage recurrence.

RESULTS: After the first treatment; six children became dry in-between catheterisations (5 without further anticholinergic medication). The last child was dry oustside episodes of UTI. Urodynamic follow-up at two months after this injection showed normalisation of detrusor pressures in six children (24.2 +/- 7,4 cm H2O) and improvement in bladder capacity (113% +/- 22 of theoretical value). One patient needs two close injections to normalise his pressures. Minimum, all children received 3 injection of BTX-A. One patient is deceased, one family decide to stop procedure and one patient was operated for non-continent urinary diversion. Treatments continue for the others with a maximum of 8 injections currently. Mean interval between injections was 7,2 months. In our series, 3 cases of detrusor high pressure after an injection were detected. We decided to inject earlier, at 4 months, with a good result.

CONCLUSIONS: In our homogenous patient series, BTX-A injection is a good therapeutic tool for upper urinary tract function preservation and decrease in urine loss. The injections can be renewed when leakage recur or before this if hyperreflexia persist at follow-up. Most of the patients can be long-term treated with a persistent efficiency.

Source of Funding: none