What is the role of botulinum toxin in the treatment of overactive bladder (OAB) in children?

Updated: Apr 01, 2019
  • Author: Pamela I Ellsworth, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Botulinum toxin is currently being used to treat pediatric detrusor overactivity, particularly cases with a neurogenic cause. In children, a total of 50-100 IU, on average, is injected in 30-40 bladder sites. The results last 6-9 months. [42]  Although the initial results in children seem promising, researchers need to perform additional studies on this treatment approach.

Botulinum toxin interacts with the protein complex necessary for the release of acetylcholine and other transmitters from the presynaptic nerve endings and prevents the release of the transmitters from the presynaptic vesicles. This effect results in decreased muscle contractility and atrophy at the injection site. 

The use of botulinum toxin in children is limited by the need for preinjection anesthesia and the need for repeat injections. Few data are available regarding the dose, concentration, site or sites, number of injections, long-term efficacy, and side effects in both adult and pediatric patients with OAB. In adults, generalized weakness and development of resistance to the toxin has been reported. Other adverse effects reported in adults include urinary tract infection, dysuria, and urinary retention. [43, 44]

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