Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research
Abstract
:1. Introduction
2. Material and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Dik, P.; Klijn, A.J.; van Gool, J.D.; de Jong-de Vos van Steenwijk, C.C.E.; de Jong, T.P.V.M. Early Start to Therapy Preserves Kidney Function in Spina Bifida Patients. Eur. Urol. 2006, 49, 908–913. [Google Scholar] [CrossRef] [PubMed]
- Lee, B.; Featherstone, N.; Nagappan, P.; McCarthy, L.; O’Toole, S. British Association of Paediatric Urologists Consensus Statement on the Management of the Neuropathic Bladder. J. Pediatr. Urol. 2016, 12, 76–87. [Google Scholar] [CrossRef]
- Figueroa, V.; Romao, R.; Pippi Salle, J.L.; Koyle, M.A.; Braga, L.H.P.; Bägli, D.J.; Lorenzo, A.J. Single-Center Experience with Botulinum Toxin Endoscopic Detrusor Injection for the Treatment of Congenital Neuropathic Bladder in Children: Effect of Dose Adjustment, Multiple Injections, and Avoidance of Reconstructive Procedures. J. Pediatr. Urol. 2014, 10, 368–373. [Google Scholar] [CrossRef]
- Sharifiaghdas, F.; Narouie, B.; Rostaminejad, N.; Hamidi Madani, M.; Manteghi, M.; Rouientan, H.; Ahmadzade, M.; Dadpour, M. Intravesical Botulinum Toxin-A Injection in Pediatric Overactive Neurogenic Bladder with Detrusor Overactivity: Radiologic and Clinical Outcomes. Urologia 2023, 90, 357–364. [Google Scholar] [CrossRef] [PubMed]
- Danacioglu, Y.O.; Keser, F.; Ersoz, C.; Polat, S.; Avci, A.E.; Kalkan, S.; Silay, M.S. Factors Predicting the Success of Intradetrusor Onabotulinum Toxin-A Treatment in Children with Neurogenic Bladders Due to Myelomeningocele: The Outcomes of a Large Cohort. J. Pediatr. Urol. 2021, 17, 520.e1–520.e7. [Google Scholar] [CrossRef]
- Madec, F.X.; Suply, E.; Forin, V.; Chamond, O.; lalanne, A.; Irtan, S.; Audry, G.; Lallemant, P. Repeated Detrusor Injection of Botulinum Toxin A for Neurogenic Bladder in Children: A Long Term Option? Prog. Urol. 2022, 32, 319–325. [Google Scholar] [CrossRef]
- Hui, C. Safety and Efficacy of Trigonal BTX-A Injections for Children with Neurological Detrusor Overactivity Secondary to Spinal Cord Injury. J. Pediatr. Surg. 2020, 55, 2736–2739. [Google Scholar] [CrossRef] [PubMed]
- Ladi-Seyedian, S.S.; Sharifi-Rad, L.; Kajbafzadeh, A.M. Botulinum Toxin Type A Therapy: Intravesical Injection or Electromotive Drug Administration. Urology 2020, 142, 190–194. [Google Scholar] [CrossRef]
- Greer, T.; Abbott, J.; Breytenbach, W.; McGuane, D.; Barker, A.; Khosa, J.; Samnakay, N. Ten Years of Experience with Intravesical and Intrasphincteric OnabotulinumtoxinA in Children. J. Pediatr. Urol. 2016, 12, 94.e1–94.e6. [Google Scholar] [CrossRef]
- Khan, M.K.; VanderBrink, B.A.; DeFoor, W.R.; Minevich, E.; Jackson, E.; Noh, P.; Reddy, P.P. Botulinum Toxin Injection in the Pediatric Population with Medically Refractory Neuropathic Bladder. J. Pediatr. Urol. 2016, 12, 104.e1–104.e6. [Google Scholar] [CrossRef]
- Kim, S.W.; Choi, J.H.; Lee, Y.S.; Han, S.W.; Im, Y.J. Preoperative Urodynamic Factors Predicting Outcome of Botulinum Toxin-A Intradetrusor Injection in Children with Neurogenic Detrusor Overactivity. Urology 2014, 84, 1480–1484. [Google Scholar] [CrossRef]
- Austin, P.F.; Franco, I.; Dobremez, E.; Kroll, P.; Titanji, W.; Geib, T.; Jenkins, B.; Hoebeke, P.B. OnabotulinumtoxinA for the Treatment of Neurogenic Detrusor Overactivity in Children. Neurourol. Urodyn. 2021, 40, 493–501. [Google Scholar] [CrossRef] [PubMed]
- Peyronnet, B.; Even, A.; Capon, G.; De Seze, M.; Hascoet, J.; Biardeau, X.; Baron, M.; Perrouin-Verbe, M.A.; Boutin, J.M.; Saussine, C.; et al. Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism. J. Urol. 2018, 200, 875–880. [Google Scholar] [CrossRef]
- Sekerci, C.A.; Tanidir, Y.; Garayev, A.; Akbal, C.; Tarcan, T.; Simsek, F. Clinical and Urodynamic Results of Repeated Intradetrusor Onabotulinum Toxin A Injections in Refractory Neurogenic Detrusor Overactivity: Up to 5 Injections in a Cohort of Children with Myelodysplasia. Urology 2018, 111, 168–175. [Google Scholar] [CrossRef] [PubMed]
- Peeraully, R.; Lam, C.; Mediratta, N.; Patel, R.; Williams, A.; Shenoy, M.; Fraser, N. Intradetrusor Injection of Botulinum Toxin A in Children: A 10-Year Single Centre Experience. Int. Urol. Nephrol. 2019, 51, 1321–1327. [Google Scholar] [CrossRef]
- Righetto, M.; Mancini, M.; Modonutti, D.; Calpista, A.; Beltrami, P.; Dal Moro, F. Patients with renal transplant and moderate-to-severe LUTS benefit from urodynamic evaluation and early transurethral resection of the prostate. World J. Urol. 2021, 39, 4397–4404. [Google Scholar] [CrossRef] [PubMed]
- Mohajerzadeh, L.; Tabari, A.K.; Atqiaee, K.; Vosoughi, A.; Lotfollahzadeh, S. The Effects of Botulinum Toxin Injection on Urodynamic Changes in Pediatric Population with Neurospastic Bladder: First Trial in Iran. J. Pediatr. Surg. 2020, 55, 2517–2520. [Google Scholar] [CrossRef]
- Tarcan, T.; Akbal, C.; Şekerci, C.A.; Top, T.; Şimşek, F. Intradetrusor Injections of Onabotulinum Toxin-A in Children with Urinary Incontinence due to Neurogenic Detrusor Overactivity Refractory to Antimuscarinic Treatment. Korean J. Urol. 2014, 55, 281–287. [Google Scholar] [CrossRef] [PubMed]
- Marte, A. Onabotulinumtoxin A for Treating Overactive/Poor Compliant Bladders in Children and Adolescents with Neurogenic Bladder Secondary to Myelomeningocele. Toxins 2013, 5, 16–24. [Google Scholar] [CrossRef]
- Wu, S.-Y.; Chang, S.-J.; Yang, S.S.-D.; Hsu, C.-K. Botulinum Toxin Injection for Medically Refractory Neurogenic Bladder in Children: A Systematic Review. Toxins 2021, 13, 447. [Google Scholar] [CrossRef]
- Softness, K.A.; Thaker, H.; Theva, D.; Rajender, A.; Cilento, B.G.; Bauer, S.B. Onabotulinumtoxin A (Botox): A Reasonable Alternative for Refractory Neurogenic Bladder Dysfunction in Children and Young Adults. Neurourol. Urodyn. 2021, 40, 1981–1988. [Google Scholar] [CrossRef] [PubMed]
Reference | Year | Type of Study | Number of Patients (N) | Mean Age (Years) | Diagnosis (N) | Inclusion Criteria | Treatment Modality | Preoperatory Urodynamic Parameters | Previous Treatments | Treatment Duration | Follow-Up | Adverse Events (N) | Outcomes |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[4] | 2022 | Retrospective, single center | 35 | 9.5 | Overactive neurogenic bladder (not specified) | Patients aged 1–18 years with the diagnosis of overactive neurogenic bladder proven by clinical evaluation, nervous system imaging, and urodynamic studies and with overreactive bladder symptoms and deterioration of urinary tract function and imaging | 10 U/kg diluted with 6 mL of normal saline; 20–30 points of injection in the bladder intra detrusor and away from the bladder neck and ureteral orifices | Frequency, nocturia, urge urinary incontinence (UUI), urgency, enuresis, and hydronephrosis | CIC | Single injection | 6 months | Positive urine culture without symptoms (3); UTI (1); temporary urinary retention (1) | 93% satisfied |
[16] | 2021 | Retrospective, single center | 34 | 15.5 | Myelomeningocele (14), transverse myelitis (3), lipomeningocele (7), and other (10) | Detrusor overactivity refractory to medical therapy, intolerance of oral therapy (oxybutynin, tolterodine, trospium, glycopyrrolate, solifenacin, or mirabegron, either individually or concomitantly), urinary incontinence between CIC and hydronephrosis refractory to medical therapy, symptomatic DO or DO on UDS (defined as a rise in detrusor pressure >15 cm H2O above baseline) or low compliance (reflected in UDS as a substantial rise in pressure at an appropriate age-specific volume to maintain CIC at 4 hourly intervals), or presence or worsening of hydronephrosis | 4.3 U/kg, 20 points of injection in the bladder, and trigone-sparing sites (1 mL per site) | High- (Pdetmax > 20 cm H2O) and low-pressure bladder (Pdetmax ≤ 20 cm H2O), high compliance (>10 mL/cm H2O), low compliance (≤10 mL/cm H2O), and finally low (<50% of expected cystometric capacity (CC)) and normal bladder capacity (≥50% of expected CC), defined as observed or estimated bladder capacity (mL/mL) | Oxybutynin, tolterodine, trospium, glycopyrrolate, solifenacin, or mirabegron, either individually or concomitantly | Single injection | NR * | NR | Success 13 (38.2%), failure 21 (61.8%) |
[5] | 2021 | Retrospective, single center | 62 | 9.1 | Myelomeningocele (62) | CIC use before BoNT-A injections and failed or non-tolerated oral anticholinergic treatments | 10 U/kg diluted with 0.9% NaCl (maximum dose of 300 U); 20–30 points of injection | 27.4% (n = 17) of patients had hypocompliant bladders without detrusor overactivity (DOA), 38.7% (n = 24) of patients had normal bladder compliance with DOA, and 33.9% (n = 21) of patients had hypocompliant bladders with DOA | Anticholinergic agents + CIC | Single injection. After mean follow-up of 28.5 12.2 months (range: 11–72 months), 54.8% (n = 34) of patients had repeated injections (from two to seven injections), resulting in total number of 117 BoNT-A injections performed. Median interval between two injections was 13.1 months. | 28.5 months | Febrile urinary infection (4) | Success was achieved in 64.5% (n = 40) of patients after first injection. The mean MCC increased from 172.4 (45.6 mL) to 236.3 (67.2 mL). The mean bladder compliance increased from 14.8 (8.1 mL/cm H2O) to (19.3 7.4 mL/cm H2O), and the mean maximum detrusor pressure decreased from 56.7 (18.8 cm H2O) to 36.6 (10.1 cm H2O). Reflux disappeared in 53.8% (n = 14) of the ureters, improved in 26.9% (n = 7), and remained unchanged in 19.2% (n = 5). |
[6] | 2021 | Retrospective, single center | 17 | 8 | Open dysraphism (1); closed dysraphism (7); post-tumoral resection (3); post-traumatic (1); post-encephalo-myelitis (3); Hinman syndrome (2) | Patients referred for neurogenic bladder-related issues and treated with at least 4 IDI-TBA | 10 U/kg (maximum of 300 U) diluted in normal saline; 30 points of injection in detrusor (1 mL/spot) | Bladder capacity (mean) = 112 mL; bladder capacity ratio (%) = 36.1; detrusor pressure (mean) = 42 cm H2O | Anticholinergic agents + CIC | A total of 95 IDI-TBA, median per patient of 5 [4,5,6,7,8] (8: n = 2—11.8%, 7: n = 4—23.5%, 6: n = 0; 5: n = 7—41.2%, 4: n = 4—23.5%); median interval = 357 days in case of clinical or cystometric deterioration | 57 months | Pielonefritis (14 in 6 patients); changes in renal morphology (3) | Bladder capacity (mean): 200 mL after 1st treatment; 220 mL at the end of treatment. Bladder capacity ratio (%): 80.3 after 1st treatment; 57.1 at the end of treatment. Detrusor pressure (mean): 8 cm H2O after 1st treatment; 16 cm H2O at the end of treatment. |
[7] | 2020 | Prospective, multi-centric | 33 | 15.6 | Traumatic injury 28; spinal surgery 5 | Spinal cord injury with stable neurologic status; urodynamic detrusor overactivity; resistance or noncompliance to two or more anticholinergic medications; participants’ parents or their caregivers agreed to perform clean intermittent catheterization | 10 U/kg (maximal dose = 200 U) diluted in a total of 30 mL sterile saline; 30 points of injection | Maximum detrusor pressure = 45.83 cm H2O (mean); volume = 163.44 mL (mean) | Anticholinergic agents + CIC | Single injection | 12 weeks | Mild transient hematuria during first week after injection (3) | Maximum detrusor pressure = 32.15 cm H2O (mean); volume = 246.01 mL (mean). Urinary incontinence episodes (mean): 4.01 (prior), 2.76 (post). Voiding volume (mL): 183.16 (prior), 280.02 (post). Dryness: n = 0 (prior), 4 (post). I-QoL = incontinence quality of life questionnaire: 40.68 (prior), 50.13 (post); p < 0.05 for all outcomes. |
[12] | 2020 | Prosepctive, multi-centric, randomized, double-blind | 113 | 11.3 | Spinal dysraphism (99); spinal cord injury (13); transverse myelitis (1) | Patients inadequately managed with anticholinergic agents, regularly using CIC (≥3 times/day for ≥3 months before screening), having ≥ 4 episodes of daytime UI over a 2 day diary | 20 intradetrusor injections of 0.5 mL excluding the trigone; Group 50 received 50 U, Group 100 received 100 U, Group 200 received 200 U | Group 50: maximum detrusor pressure during storage phase of 58.2 cm H2O (mean); maximum cystometric capacity of 169.1 mL (mean); involuntary detrusor contraction = 94.4%. Group 100: maximum detrusor pressure during storage phase of 56.5 cm H2O (mean); maximum cystometric capacity of 179.2 mL (mean); involuntary detrusor contraction = 88.1%. Group 200: maximum detrusor pressure during storage phase of 56.7 cm H2O (mean); maximum cystometric capacity of 202.3 mL (mean); involuntary detrusor contraction = 92.6% | Anticholinergic agents + CIC | Single injection | 48 weeks | UTI (33) | Improvements from baseline in number of daytime UI episodes in all dose groups; after 6 weeks, the majority of patients in each group reported “great improvement” or “improvement” in TBS; dose-dependent increase in functional bladder capacity, measured by volume at first morning catheterization recordings; significant improvement from baseline in urodynamic storage pressures; and increase from baseline to week 6 in maximum cystometric pressure in all dose groups |
[8] | 2020 | Retrospective, single center | 26 | 7.7 | Mielomeningocele (26) | Children with MMC older than 3 years of age who had moderate-to-severe urinary incontinence with urodynamically proven neurogenic detrusor over activity (NDO). Spontaneous detrusor contraction during filling phase causing detrusor pressure increase to >15 cm H2O from the baseline; high detrusor pressure (>40 cm H2O) | 10 U/kg diluted in 20 mL of normal saline; at least 40 points of injection sparing trigone and ureteral orifices | Mean maximal detrusor pressure (cm H2O), maximal cystometric capacity (mL), mean detrusor compliance (mL/cm H2O), median urinary incontinence score (0–3), and urinary incontinence score (0–3) | Anticholinergic agents + CIC | Single injection | 1 year | NR | 8 of 12 (66.6%) patients became completely dry between 2 consecutive clean intermittent catheterizations, which were maintained in 6 of 12 (50%) patients |
[17] | 2020 | Prospective, mono-centric | 20 | 7.7 | Myelomeningocele: 18; post-surgery: 2 | Patients who did not respond to anticholinergic medications or could not tolerate side effects | 2 mg/kg per day diluted in normal saline; 40 square-shaped areas 1 cm on each side away from trigone; approximately 10 U were injected into posterior and anterior walls | Mean: Flow rate in second two (mL/s) = 6.6; flow time of diuresis (s) = 59.77; peak flow time (s) = 16.98; flow average = 7.71; discharged volume (mL) = 106.84; maximum detrusor muscle filling pressure (cm H2O) = 86.03; maximum flow (mL) = 13.87; acceleration (mL/s2) = 1.25; post-void residual volume (mL) = 9.02; compliance (mL/cm H2O) = 7.85; cystometric bladder capacity (mL) = 115.41 | Oxibutinine, anticholinergics | Single injection | NR | NR | 3 months later (mean): flow rate in second two (mL/s) = 7.09, p = 0.60; flow time of diuresis (s) = 48.61, p = 0.03; peak flow time (s) = 15.49, p = 0.12; flow average = 7.30, p = 0.32; discharged volume (mL) = 128.90, p < 0.005; maximum detrusor muscle filling pressure (cm H2O) = 72.03, p < 0.005, maximum flow (mL) = 13.57, p = 0.30 acceleration (mL/s2) = 1.28, p = 0.34; post-void residual volume (mL) = 5.47, p = 0.02; compliance (mL/cm H2O) = 2.12, p = 0.002; cystometric bladder capacity (mL) = 134.38, p = 0.002 |
[15] | 2019 | Retrospective, single center | 28 | 11.1 | Open myelomeningoceles (17), tethered cord within lipomatous mass with associated sacral agenesis (1), cerebral palsy and idiopathic congenital dystonia (10) | Involuntary voiding or urinary incontinence between CICs, where all received oral anticholinergics and had urodynamically proven impaired bladder compliance, DO, or reduced bladder capacity | 375 U or 500 U (not in those <12 years) of DysportTM diluted with normal saline to total volume of 20 mL (concentration of either 18.75 U/mL or 25 U/mL); 20 points of injection equally distributed in detrusor muscle, sparing trigone | NR | Anticholinergic agents + CIC | Repeated injection if no effects or waning response; mean = 14 months | 25 months | Difficulty initiating voiding (1); UTI (1) | 8 did not improve, 14 mildly improved, 6 dry |
[13] | 2018 | Retrospective, multicenter | 53 | 8.5 | Myelomeningoceles (25), closed spinal dysraphisms (28) | Patients under CIC and not receiving therapeutic botulinum toxin (for any indication) in previous 3 months, with no history of myasthenia or coagulation disorders | No standardized dose due to retrospective nature of study | 14 patients (26.4%) had poor compliance in bladder and detrusor overactivity, 11 patients (20.7%) had poor compliance in bladder without detrusor overactivity, and 18 patients (34%) had detrusor overactivity with normal bladder compliance. In 10 patients, pre-injection urodynamic data were not available or incomplete. | Anticholinergic agents + CIC | 33 (62.3%) had repeated injections (from 2 to 8 injections) resulting in total number of 141 IBTX-A runs performed. Time interval between injections not reported. | 3.7 years | Urinary tract infections (3) | CLINICAL: Most patients were clinically improved after first IDBTX-A run. The clinical success rate was 66%. URODYNAMIC: Compliance (mL/cm H2O) = 9.9 (prior), 16.3 (post) (mean); p < 0.05. Maximum cystomanometric capacity (mL) = 184.4 (prior), 268.8 (post) (mean); p > 0.05. Maximum detrusor pressure (cm H2O) = 47.3 (prior), 34.5 (post) (mean); p < 0.05. |
[14] | 2017 | Retrospective, single center | 19 | 10.3 | Myelodysplasia (19) | NDO due to myelodysplasia refractive to standard treatment protocol with anticholinergics and CIC | 100 U diluted with 10 mL of normal saline; 20 points of injection into bladder, sparing trigone; each injection had volume of 1 mL and held 10 U | Maximum cystometric capacity, maximum detrusor pressure, compliance | Anticholinergic agents + CIC | 1–5 injections (every 3 months) | 4 years | Hematuria (2) | Significant improvements in mentinal parameters after repeat injections |
[9] | 2015 | Retrospective, single center | 53 | 8 | Spina bifida (18); acquired spinal cord injury (4); cerebral palsy (3); trnasverse myelitis (1); intraspinal lipoma (1); post pelvic surgery (1); acquired brain injury (1); idiopathic (24) | Failure of conservative treatment | 10 U/kg diluted in normal saline (maximum 300 U). Multiple injections were distributed throughout detrusor at 10 units/kg to maximum of 300 units. For intrasphincteric injections = 3 U/kg diluted in normal saline (maximum of 100 U) | NR | Anticholinergic agents, CIC, tamsulosin, midazolam | 134 injections in 53 children (106 intravesical, 23 intrasphincteric, 5 combined); mean of 2.57 injections per patient (range: 1–11); time interval not reported | 26–79 months | UTI in 2 week period post injection (13) | After each Botox injection, all children responded to meet ICCS category of response; >90% reduction in symptoms |
[10] | 2015 | Retrospective, single center | 22 | 10 | Myelomeningocele (10); MAR (3); spinal cord trauma (3); tethered cord (2); caudal regression syndrome (2); sacrococcygeal teratoma (1); transverse myelitis (1) | Failure of CIC and anticholinergic treatment | 10 U/kg diluted with normal saline (maximum 300 U) injected into detrusor along posterior and lateral walls while sparing trigone | Cystometric bladder capacity (mean) = 227 mL; mean maximum detrusor (mean) = 63 cm H2O; compliance (mean) = 4.3 mL/cm H2O | Anticholinergic agents + CIC | Four patients in cohort (18%) had received two or more BTIs; time interval not reported | NR | NR | Cystometric bladder capacity improved by 46% (227 vs. 331 mL, p = 0.008). The mean maximum detrusor pressure decreased by 43% (63 vs. 44 cm H2O, P Z 0.002), and mean compliance improved by 104% (4.3 vs. 8.8 mL/cm H2O, p = 0.001), with urodynamics performed at 12 weeks following procedures. Overall, 54% (n = 12) had improved continence after initial BTI, whereas 45% (n = 10) achieved complete continence with prescribed CIC. A total of 75% of AI patients (n = 3/4) were continent with CIC after initial BTI. The mean duration of clinical improvement after the initial BTI was 4.6 months (range: 0–18). |
[11] | 2014 | Retrospective, single center | 37 | 7.5 | Spina bifida (29); syrinx (1); cerebral palsy (4); Guillain–Barre syndrome (1); spinal cord hemangioma (1); post-meningitis sequelae (1) | Neurogenic detrusor overactivity refractive to high-dose anticholinergics | 10 IU/kg (maximal 300 IU), diluted in normal saline to concentration of 10 U/cc | NR | Anticholinergic agents + CIC | Repeated injections (4 patients received 2 or more injections for recurrence of symptoms); time interval not reported | 11 months | NR | Patients with anticholinergics intolerance seen to be more effective after BTX-A injection than those with anticholinergic refractory |
[18] | 2014 | Prospective, single center | 31 | 9.7 | Myelomeningocele | NB with urinary incontinence managed without success with CIC and oxybutynin for at least 2 months | 10 IU/Kg (maximum = 300 IU), diluted in normal saline (1 mL in each injection, 20 or 30 injections) | P = Pdetmax (cm H2O); MCC = maximum cystometric capacity (mL); BC = bladder compliance (mL/cm H2O) | CIC and oxybutynin for at least 2 months | One or more injections, depending on follow-up | 29 w | 9 UTI | 30 with dryness with CIC, P reduction of 53%, MCC reduction of 51.5%, 324% increase in BC |
[19] | 2013 | Retrospective, single center | 47 | 10.7 | Myelomeningocele | Neurological patients with overactive or poorly compliant bladders on CIC and resistant or non-compliant to pharmacological therapy; inceontinence with CIC | 12 IU/Kg (maximum = 200 IU), diluted in 20 cc of normal saline | Mean leak point volume before and after injection (124.8 mL vs. 207 mL), mean leak point pressure before and after injection (38.2 vs. 38.4), specific capacity at 20 cm H2O (69.8 vs. 152.6) | Anticholinergic agents + CIC | One or more injections, depending on control, at 12 weeks or after recurrence of symptoms (6–9 m) | 5.7 y | 38 with slight hematuria for 2–3 days, 2 with UTIs, 2 with gastric pain, 2 with facial flushing, 5 with mild hypostenia | 37 with dryness with CIC (10 with Ach therapy), 9 with improved incontinence |
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Zulli, A.; Carletti, V.; Mantovani, A.; Cerruto, M.A.; Giacomello, L. Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research. Toxins 2024, 16, 339. https://doi.org/10.3390/toxins16080339
Zulli A, Carletti V, Mantovani A, Cerruto MA, Giacomello L. Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research. Toxins. 2024; 16(8):339. https://doi.org/10.3390/toxins16080339
Chicago/Turabian StyleZulli, Andrea, Virginia Carletti, Alberto Mantovani, Maria Angela Cerruto, and Luca Giacomello. 2024. "Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research" Toxins 16, no. 8: 339. https://doi.org/10.3390/toxins16080339