Success Rate and Predicting Factors for Repeated High-Dose Intradetrusor Dysport Injections in Children With...

Area of Science:

• Pediatric Urology
• Neuroscience
• Pharmacology

Background:

• Pediatric neurogenic bladders often present challenges in management, particularly when refractory to standard medical treatments.
• Intradetrusor abobotulinumtoxin A (Dysport®) has emerged as a therapeutic option, but data on repeated high-dose efficacy in children are limited.

Purpose of the Study:

• To evaluate the effectiveness and safety of repeated high-dose intradetrusor abobotulinumtoxin A (Dysport®) injections.
• To assess treatment outcomes in pediatric patients with neurogenic bladders unresponsive to conventional medications.

Main Methods:

• A retrospective interventional study involving 37 children (median age 9.2 years) with neurogenic bladders failing medical treatment.
• Participants received intra-detrusor Dysport® injections (30 IU/kg, up to 1000 IU) under general anesthesia.
• Video urodynamic testing was performed pre-treatment and post-injection; repeated injections were administered based on cystometric parameter improvement.

Main Results:

• The overall treatment success rate was 62%, defined by decreased end-filling pressure (<40 cm H2O) and/or increased maximal cystometric capacity (≥20%).
• Maximal cystometric capacity significantly increased with each subsequent injection (30%, 37%, 45%), and end-filling pressure decreased significantly (from 45 cm H2O to 20 cm H2O).
• No adverse side effects were reported; no predictive factors for success were identified, though some 'end-stage' bladders showed improvement.

Conclusions:

• High-dose abobotulinumtoxin A (Dysport®) injections represent a safe and effective treatment modality for pediatric neurogenic bladders.
• The study suggests considering Dysport® for 'end-stage' bladders prior to surgical augmentation.
• Further research with larger cohorts and control groups is recommended to identify specific patient subgroups who would benefit most.