Experience with Intravesical Botox in Meningomyelocele-Related Bladder Dysfunction-A Single-Center Experience

Abstract

Neurogenic bladder dysfunction as a secondary effect of meningomyelocele (MMC) is a serious risk factor of urinary incontinence, vesicoureteral reflux, and progressive upper urinary tract degradation. This was a prospective, single-centre, study that assessed the short-term effectiveness of intravesical onabotulinumtoxinA (Botulinum toxin type A) in children with refractory neurogenic bladder related to MMC. Ten hyper-reflexive neurogenic bladder children who were unresponsive or intolerant to anticholinergic treatment and clean intermittent catheterization were injected with intrapetrous onabotulinumtoxinA (10 IU/kg) under cystoscopic guidance. The baseline and 3 and 6 months post-treatment assessments were conducted on the urodynamic parameters, the state of continence, bowel symptoms, and vesicoureteral reflux. Three months later, the detrusor sphincter dyssynergia was reduced significantly, the maximum detrusor pressure also decreased significantly, the bladder capacity was higher, the post-void residual volumes were lower, and the grades of continence were better. The moderate grades of vesicoureteral reflux had significant improvement on follow-up voiding cystourethrography. In spite of the fact that partial attenuation of therapeutic effects was observed at 6 months, the results were better than baseline. Also, constipation was improved in most of the patients. These results justify the use of intravesical onabotulinumtoxinA as a safe and useful minimally invasive therapeutic intervention in the short-term management of the bladder in children with MMC-related neurogenic bladder, which may delay or prevent more invasive surgical procedures.