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CONGRESS OF THE ESPU
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BOTULINUM TOXIN TYPE-A INJECTIONS
FOR THE TREATMENT OF CONTINENT CATHETERIZABLE
RESERVOIR MUSCULARIS OVERACTIVITY IN PEDIATRIC
PATIENTS
Luis SIERRA, Laia SABIOTTE, Erika LLORENS and Anna BUJONS
Fundació Puigvert, Pediatric urology Unit, Barcelona, SPAIN
PURPOSE
Continent catheterizable reservoirs can exhibit complications such as high pressures and involun-
tary unit contractions. The use of onabotulinum toxin-A injections could be a treatment to explore.
The purpose is to evaluate the efficacy and safety of intravesical injection of onabotulinumtoxinA
(BOTOX) as a treatment in the management of overactive bladder in patients with continent cath-
eterizable reservoirs.
MATERIAL AND METHODS
A prospective study was carried between 2013–2016 to evaluate the efficacy of botulinum toxin
treatment in pediatric patients with mean age of 14 years old (R 8–16) with muscularis overactivity
in continent catheterizable reservoirs after failing maximal doses of oral anticholinergic medications.
Urodynamic studies demonstrated phasic neobladder overactivity: 95 mL (up to 40 cm H2O) and
173 mL (up to 83 cm H2O with leakage).
These patients underwent reservoir injections under general anesthesia via appendicovesicostomy.
The initial dose used was 200 units and was increased to 300 units in 20 separate injection sites to
improve results and durability.
RESULTS
11 injections of BOTOX were performed in 6 patients. All patients improved their incontinence and
urgence after BOTOX. Postinjection urodymamic studies showed normal filling with improvement
of overactivity bladder. Mean time to relapse of symptoms after injection of BOTOX was 8 months
(R6–12). There were no complications in any cases. Mean time to reinjection of botox was
14 months (R9–18). Average follow-up time 48 months (R 12–36).
CONCLUSIONS
Intravesical injection of BOTOX may be considered as a treatment option for overactive symptoms
in patients with continent catheterizable reservoirs, although further studies are needed to verify the
complications and long-term outcomes of this procedure.