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158
29
th
CONGRESS OF THE ESPU
08:16–08:19
S21-3 (PP)
★
EFFICACY OF ELECTROMOTIVE DRUG ADMINISTRATION
(EMDA) OF BOTULINUM TOXIN A IN CHILDREN WITH
NEUROPATHIC BLADDER - OUTCOMES OF A PILOT STUDY
Claudia KOH
1
, Charlotte MELLING
1
, Cheryl JENNINGS
1
, Malcolm LEWIS
2
and Anju
GOYAL
1
1) Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester
Children's Hospital, Paediatric Nephrology, Manchester, UNITED KINGDOM
PURPOSE
Intravesical injection of Botulinum toxin A (BtA) is well-established in managing neuropathic bladder
dysfunction. EMDA uses pulsed direct electrical current to enhance trans-urothelial drug delivery
and has been used for Mitomycin C, oxybutynin and lidocaine. It has been reported to be effective
for BtA delivery in children. This prospective study assessed the efficacy of EMDA of BtA (Botox
®
)
in children with neuropathic bladder dysfunction.
MATERIAL AND METHODS
Ten children with urodynamically confirmed neuropathic bladder were administered BtA (Botox
®
) via
EMDA. Patients received between 3.3.units/kg and 10 units/kg (max 300) of Botox
®
. Urodynamic
studies were performed according to ICCS standards, before and 4–6 weeks after EMDA. Using
SPSSv24, the Wilcoxon test objectively assessed four variables: Bladder Capacity (% of EBC),
Compliance, pDetmax during detrusor overactivity and at capacity. Data are described using
median (IQR), pre and post-EMDA unless stated, with statistical significance defined as p <0.05.
RESULTS
Ten patients aged 12.6yrs (range 7.6–16.9yrs) had EMDA following baseline urodynamics.
9/10 completed post-intervention urodynamics. There were no adverse effects attributable to
EMDA. Statistically significant improvement in urodynamic parameters was not seen. Bladder
capacity (% of EBC) was 59.5(41.2–91 %) vs 53.0(34.5–76 %), p=0.678. Bladder compliance was
8.75(6.88–11.05 mls/cmH2O) compared with 9.0(2.85–11 mls/cmH2O), p=0.327. Pdetmax dur-
ing filling was 49(40.75–88 cmH2O) compared to 91(45.5–142.5 cmH2O), p=0.374. At capacity,
pdetmax was 28(21.75–40.5 cmH2O) vs 49(25.5–60 cmH2O), p=0.110.
CONCLUSIONS
EMDA offers potential economic and practical advantages of administering BtA without requiring
general anaesthetic. However, we could not demonstrate any objective improvement in urodynamic
parameters in neuropathic bladder dysfunction. This questions the ability of EMDA to transport BtA
molecules across urothelium.