BTX-A safe, effective for kids with refractory OAB

Children with refractory overactive bladder (OAB) benefit from botulinum toxin-A (BTX-A) injections, which can safely enlarge bladder and suppress OAB symptoms, a recent study has found.

Drawing from their medical charts, researchers retrospectively assessed 53 children (median age 9.9 years, 41 boys) who received BTX-A injections for refractory, non-neurogenic OAB. The outcome of interest was the functional bladder volume (FBV), expressed as the percentage of the expected bladder capacity for age.

Researchers reported a significant FBV increase from a median of 52.9 percent to 70 percent (p=0.000). Meanwhile, nine children (18 percent) achieved full continence after BTX-A injection in the short term, while 26 percent (n=13) did so by the 6-month follow-up. In contrast, OAB symptoms of urgency and frequency persisted in 20 percent and 28 percent of children, respectively, after the injection.

Multivariate logistic regression analysis revealed that a higher dose of BTX-A significantly predicted symptom improvement <6 months after injection (odds ratio [OR], 1.02, 95 percent confidence interval [CI], 1.001–1.039; p=0.042).

In comparison, significant correlates of long-term improvement (6–12 months) were FBV before injection (OR, 0.935, 95 percent CI, 0.880–0.993; p=0.03) and sex (boys vs girls; OR, 0.032, 95 percent CI, 0.002–0.430; p=0.009). These findings suggested that boys were more likely to derive benefit from BTX-A injections than girls.

In terms of safety, the BTX-A injection led to urinary tract infection in five children, all cases of which developed >14 days after administration. Haematuria, urinary retention requiring prolonged intermittent self-catheterization, and systemic side effects were also documented, albeit uncommonly.