ESPU Congress 2018 - Abstract Book

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.