The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding – A systematic review

S. A.A. Hoelscher; I. B. de Angst; Z. A. Buijnsters; W. M. Bramer; F. W. Akkermans; M. E. Kuindersma; J. R. Scheepe; Lisette A.’t Hoen

doi:10.1016/j.jpurol.2023.10.034

The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding – A systematic review

S. A.A. Hoelscher^*, I. B. de Angst^*, Z. A. Buijnsters, W. M. Bramer, F. W. Akkermans, M. E. Kuindersma, J. R. Scheepe, Lisette A.’t Hoen^*

^*Corresponding author for this work

Research output: Contribution to journal › Review article › Academic › peer-review

4 Citations (Scopus)

9 Downloads (Pure)

Abstract

Introduction:

Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV.

Objective:

The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children.

Methods:

A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted.

Results:

From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33–69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects.

Conclusions:

BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.

Original language	English
Pages (from-to)	211-218
Number of pages	8
Journal	Journal of Pediatric Urology
Volume	20
Issue number	2
DOIs	https://doi.org/10.1016/j.jpurol.2023.10.034
Publication status	Published - Apr 2024

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Publisher Copyright:
© 2023 The Authors

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The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voidingFinal published version, 703 KBLicence: CC BY

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@article{0d64c256c839468da56f6a49f487f2d6,

title = "The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding – A systematic review",

abstract = "Introduction:Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV.Objective: The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children. Methods: A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted. Results: From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33–69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects. Conclusions: BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.",

author = "Hoelscher, {S. A.A.} and {de Angst}, {I. B.} and Buijnsters, {Z. A.} and Bramer, {W. M.} and Akkermans, {F. W.} and Kuindersma, {M. E.} and Scheepe, {J. R.} and Hoen, {Lisette A.{\textquoteright}t}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = apr,

doi = "10.1016/j.jpurol.2023.10.034",

language = "English",

volume = "20",

pages = "211--218",

journal = "Journal of Pediatric Urology",

issn = "1477-5131",

publisher = "Elsevier Ltd.",

number = "2",

}

TY - JOUR

T1 - The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding – A systematic review

AU - Hoelscher, S. A.A.

AU - de Angst, I. B.

AU - Buijnsters, Z. A.

AU - Bramer, W. M.

AU - Akkermans, F. W.

AU - Kuindersma, M. E.

AU - Scheepe, J. R.

AU - Hoen, Lisette A.’t

PY - 2024/4

Y1 - 2024/4

N2 - Introduction:Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV.Objective: The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children. Methods: A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted. Results: From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33–69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects. Conclusions: BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.

AB - Introduction:Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV.Objective: The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children. Methods: A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted. Results: From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33–69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects. Conclusions: BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.

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U2 - 10.1016/j.jpurol.2023.10.034

DO - 10.1016/j.jpurol.2023.10.034

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AN - SCOPUS:85180326274

SN - 1477-5131

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JO - Journal of Pediatric Urology

JF - Journal of Pediatric Urology

IS - 2

ER -

The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding – A systematic review

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