Botulinum toxin injections for paediatric incontinence

PURPOSE OF REVIEW: This review highlights a recent innovation in the medical treatment of children with neurogenic detrusor overactivity. Anticholinergics are usually the main way to treat bladder overactivity. Side effects and lack of efficacy are the two main causes for considering alternative treatment. Up to recently, invasive surgery, mainly bladder augmentation, was the only available treatment for these intractable bladders. Here, we report on botulinum A toxin injection as an alternative to surgery in children with neurogenic detrusor overactivity. RECENT FINDINGS: There are only four published articles on the use of botulinum A toxin in children with neurogenic detrusor overactivity. However, an increasing number of reports indicate clinical benefit and a good safety profile of botulinum A toxin in neurogenic and idiopathic detrusor overactivity. Extrapolation of the data published in adults treated with botulinum A toxin injections and understanding the mechanism of action on the detrusor muscle are worthwhile to encourage paediatric physicians to propose this option to their patients. Furthermore, the literature does not seem to warn against drug resistance or ultrastructural changes of the detrusor after repeated injection. SUMMARY: Botulinum A toxin appears to be a reasonable alternative to surgery in the management of intractable overactive bladder in children. However, studies of the delivery method, site of injection, dose and long-term follow-up are required to confirm the good safety profile/clinical benefit of this new, minimally invasive approach.