Intravesical Botulinum Toxin Injection for Treating Detrusor Overactivity and Poor Compliance in Posterior Urethral Valves—A Preliminary Experience

ABSTRACT Purpose To report our preliminary experience on the use of Botulinum toxin A in boys with posterior urethral valves for treating detrusor overactivity and/or reduced bladder compliance not responsive to medical treatment. Material and Methods Primary outcome measures studied were change in baseline end fill pressure (pDet), compliance, maximum Detrusor overactivity pressure (DO), fractional bladder capacity (FBC), vesicoureteric reflux (VUR) grade/resolution. Secondary outcome measures were serum creatinine and estimated glomerular filtration rate (eGFR). Low compliance group was defined as rise in baseline pDet > 20 cmH 2 O. High pressure DO was defined as maximum pDet > 40 cmH 2 0. Results A total of 15 children were included in the analysis. The median decrease in end fill pDet in the whole cohort was from 20 cmH 2 O (14.5–30) to 16 cmH 2 O (10.5–22) ( p = 0.065). By analyzing the patients with low compliance, we identified a median decrease in end fill pDet from 32 cmH 2 O (26.5–44.5) to 19 cmH 2 O (16.5–25.5) ( p = 0.028). The median change in compliance for all the boys was from 6 mL/cmH 2 O (4.51–7.3) to 12.1 mL/cmH 2 O (7.44–17.3) ( p < 0.001). The median change in compliance in the low compliance group was from 5.5 mL/cmH 2 O (4.42–7.1) to 8.8 mL/cmH 2 O (7.39–13.3) ( p = 0.018). The median change in fractional bladder capacity for all the boys was from 0.70 (0.55–0.92) to 0.98 (0.79–1.42) ( p = 0.061). A complete resolution of DO was observed in 7 out of 11 patients. Complete resolution of VUR was observed in 5 out of 8 renal units. Conclusion Botulinum toxin A can be considered in the treatment strategy for reduced bladder compliance and detrusor overactivity in boys with PUV. Trial Registration: 15894.