A Novel Approach to Botulinum Toxin Injection for Neurogenic Detrusor Overactivity in Children

Botulinum toxin (BoNT) injections into the bladder wall have become a well-established treatment for various bladder disorders, particularly neurogenic detrusor overactivity (NDO) and overactive bladder (OB) in both adults and children. However, challenges persist with injection techniques, as up to 40% of BoNT can inadvertently be injected into the extravesical space, leading to reduced treatment efficacy. There are two primary methods for administering BoNT: submucosal and intravesical injections, each employing distinct techniques to ensure precise drug delivery. A novel technique referred to as mucosal lifting was evaluated in 20 young patients with NDO. This method is a modification of the traditional submucosal injection technique, where the bladder mucosa is lifted to create a suitable space for injection. Results demonstrated a significant increase in dryness time between clean intermittent catheterizations, with an average improvement from 8.9 months to 11.8 months, indicating enhanced efficacy. Despite these encouraging findings, the small sample size limits the generalizability of the study's conclusions.