The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding - A systematic review.

Autor: Hoelscher SAA; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: s.hoelscher@erasmusmc.nl., de Angst IB; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: i.deangst@erasmusmc.nl., Buijnsters ZA; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., Bramer WM; Medical Library, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., Akkermans FW; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., Kuindersma ME; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., Scheepe JR; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands., Hoen LA'; Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. Electronic address: l.thoen@erasmusmc.nl.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2024 Apr; Vol. 20 (2), pp. 211-218. Date of Electronic Publication: 2023 Nov 07.
DOI: 10.1016/j.jpurol.2023.10.034
Abstrakt: Introduction: Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV.
Objective: The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children.
Methods: A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted.
Results: From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33-69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects.
Conclusions: BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.
Competing Interests: Conflict of interest None.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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