# Efficacy and Predictive Factors of Intravesical Botulinum Toxin A Injection for Treating Neurogenic Detrusor Overactivity in Children: A Single-Center Retrospective Study

## TL;DR

This study found that injecting botulinum toxin A into the bladder may be a safe and somewhat effective treatment for children with neurogenic detrusor overactivity.

## Contribution

The study provides new evidence on the safety and potential efficacy of intravesical botulinum toxin A in pediatric neurogenic detrusor overactivity.

## Key findings

- 77.8% of patients achieved a global response assessment score of ≥2, indicating some level of improvement.
- Cystometric bladder capacity improved significantly, though not after Bonferroni correction.
- Only 11.8% of patients experienced mild febrile UTIs as adverse events.

## Abstract

Neurogenic detrusor overactivity (NDO) is a complex condition associated with detrusor overactivity, reduced bladder compliance, and high intravesical pressures, potentially leading to urinary tract infections (UTIs) and renal impairment. This retrospective study evaluated the safety and potential efficacy of intravesical botulinum toxin A (BoNT/A) injections in children with NDO at a single institution. Eighteen pediatric patients (median age: 8.1 years) were followed for a median of 6.3 years. At follow-up, 77.8% achieved a global response assessment (GRA) score of ≥2. A statistically significant improvement was found in cystometric bladder capacity (p = 0.041), but it did not remain significant after Bonferroni correction, while other urodynamic trends were not statistically significant. Adverse events were infrequent, with only 11.8% experiencing mild febrile UTIs. While some patients with poorer baseline bladder conditions reported greater subjective improvement, no statistically significant predictors of success were identified. Overall, intravesical BoNT/A injection appears to be a safe and potentially effective option for managing pediatric NDO, though larger prospective studies are needed to confirm these findings.