A MEDLINE and EMBASE search for clinical studies involving BTX-A injected into the detrusor of children with NDO or NOAB was performed, prior to data analysis.
A total of six articles evaluating the efficacy and safety of Botox® in patients with NDO and incontinence/NOAB were selected. The underlying neurological disease was myelomeningocele in 93 % of patients. Most were over 2 years of age. The most common amount of Botox injected was 10–12 U/kg with a maximal dose of 300 U, usually as 30 injections of 10 U/ml in the bladder (excluding the trigone) under cystoscopic guidance and general anaesthesia. Most of the studies reported a significant improvement in clinical (65–87 % became completely dry) as well as urodynamic (in most studies mean maximum detrusor pressure was reduced to <40 cm H2O and compliance was increased >20 ml/cm H2O) variables, without major adverse events.
Botox injections into the detrusor provide a clinically significant improvement and seem to be very well tolerated in children with NDO and incontinence/NOAB refractory to antimuscarinics.