Need for botulinum toxin injection and bladder augmentation after isolated bladder outlet procedure in pediatric patients with myelomeningocele

• Published in: Journal of pediatric urology 2020-02, Vol.16 (1), p.32.e1-32.e8
• Main Authors: Smith, Matt C., Strine, Andrew C., DeFoor, W. Robert, Minevich, Eugene, Noh, Paul, Sheldon, Curtis A., Reddy, Pramod P., VanderBrink, Brian A.
• Format: Article
• Language: English
• Subjects: Acetylcholine Release Inhibitors - administration & dosage; Adolescent; Bladder augmentation; Bladder neck procedure; Botulinum toxin; Botulinum Toxins - administration & dosage; Child; Cohort Studies; Combined Modality Therapy; Female; Humans; Injections; Male; Meningomyelocele - complications; Myelomeningocele; Neurogenic bladder; Pediatric; Retrospective Studies; Time Factors; Treatment Outcome; Urinary Bladder - surgery; Urinary Bladder, Neurogenic - etiology; Urinary Bladder, Neurogenic - surgery; Urinary Incontinence - etiology; Urinary Incontinence - surgery; Urologic Surgical Procedures - methods
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2019.10.011

In patients with neurogenic bladder outlet incompetence, a bladder outlet procedure (BOP) may be required to achieve urinary continence. However, when performed in isolation, a BOP can be associated with bladder deterioration and upper-tract injury. In the event of bladder deterioration, additional procedures such as bladder augmentation (BA) or botulinum toxin injection (BTI) may be pursued. The aim of this study was to assess long-term outcomes after isolated BOP in a pediatric myelomeningocele (MMC) population, including the need for additional surgical intervention in the form of BTI or BA. A retrospective cohort study was performed for patients with MMC who underwent an isolated BOP between 2004 and 2017. Primary outcomes included the need for postoperative BTI or BA. Secondary outcomes included the association between preoperative urodynamic parameters and need for BTI or BA. BTI or BA was performed in 18 of 36 (50%) patients at a median of 17.8 months (IQR 11.2–29.3) after an isolated BOP. A median of 1 (IQR 1–3) BTI was performed in 11 (30.6%) patients. BA was performed in 9 (25%) patients, including 2 patients who previously underwent BTI. Patients who did not undergo BTI or BA after BOP had a slightly increased percentage estimated bladder capacity at the end of follow-up (107% versus 95%, p=0.42). By contrast, patients who underwent BTI or BA had a post-BOP percentage estimated bladder capacity that decreased from 112 to 70% (p