Intravesical Botox: An Effective Therapy for Refractory Monosymptomatic Nocturnal Enuresis

Monosymptomatic nocturnal enuresis (MNE) significantly impacts many children, with substantial patient groups refractory to conventional first-line treatments. Intravesical Botox is used for various refractory functional voiding disorders in children, but its efficacy in MNE has not been widely established. This study aimed to determine the efficacy of intravesical Botox in children with refractory monosymptomatic nocturnal enuresis.

A retrospective analysis was conducted of 22 children with MNE (median age 11 years; 19 males) treated with intravesical Botox injection over a 6 year period. All participants had previously failed desmopressin, and the majority had trialled an enuresis alarm and oxybutynin. Each child received 200iU of Botox injected into the detrusor muscle. Treatment outcomes were classified as complete (100% reduction in wet nights), partial (50%-99% reduction), or no response (0%-49% reduction).

Prior to treatment, median number of wet nights was six per week. Following the final injection, complete response was observed in 8 of 22 (36%) children, partial response in 7 of 22 (32%), and no response in 7 of 22 (32%). Median reduction in wet nights was 2.5 per week. Median duration of response for those experiencing relapse was 11 months. No intra-operative complications occurred. Post-operative complications were mild and self-resolving, limited to transient haematuria/pain and dysuria in isolated cases, with no instances of urinary tract infection or retention.

Intravesical Botox injection is an effective, well-tolerated treatment option for children with refractory monosymptomatic nocturnal enuresis, demonstrating a sustained response in a significant proportion of patients. This intervention presents a valuable option for treating this multi-faceted condition.