Botox can safely prolong bladder enlargement time in some "at-risk" patients: study

Augmentation Cystoplasty (Bladder Augmentation) The bladder is the organ that holds the urine. Augmentation cystoplasty, also known as bladder augmentation, is an operation to enlarge the bladder. This surgery may be necessary for people who have trouble urinating due to certain conditions.

Delaying bladder augmentation (BA) may be desirable in a pediatric neurogenic bladder (NGB) with worsening compliance, but previous studies have questioned whether onabotulinum toxin A (BTX) shows a lasting improvement in compliance. A group of researchers presents our overall experience with BTX and its role in reducing 'at-risk' NGB as determined by urodynamic properties.

A retrospective single-institution review of all BTX procedures performed between January 2010 and October 2018 was conducted. Patients with <12 months follow-up after the first BTX injection were excluded. The National Spina Bifida Patient Registry (NSBPR), as well as urodynamic studies (UDS), were reviewed to assign institutionally developed (LCH) risk stratification groups. Patients were considered "at-risk" for bladder enlargement if they had any of the following: moderate or hostile NSBPR risk grade; LCH risk grades indicating end-fill pressure >25 cmH2O or detrusor sphincter dyssynergia (DSD); upper system changes, including new hydronephrosis; new or worsening vesicoureteral reflux; or other manifestations of a hostile urinary tract (i.e., febrile UTI). Whenever possible, UDS risk ratings were compared before and after the first BTX injection in this "at-risk" group.

Results of the study:

• Thirty-nine patients underwent 162 injection procedures during a median follow-up of 65 months between quartiles.

• The median age at first BTX was ten years, the median number of BTX injections per patient was 4, and the median time between injections was six months.

• Twenty-six patients were considered 'at risk' at the time of the first BTX injection, and 16 (61.5%) of these progressed to bladder augmentation at a median of 36 months.

• Few (four) had bladder augmentation due to upper duct changes or worsening pressures on BTX, while nine patients (five with CKD) continued bladder augmentation because there was the insufficient improvement to consider BTX as a viable long-term option.

• Post-first BTX UDS showed a downgrade of the risk group by 38% and 63% using NSBPR and LCH classifications, respectively.

Thus, the researchers concluded that encouraging improvements were noted in the urodynamic risk group in some patients. With careful counselling and follow-up, BTX can safely prolong bladder enlargement time in some "at risk" patients.

Reference:

Bowen, DK, Meyer, T, Rosoklija, I, et al. Botulinum toxin in patients at-risk for bladder augmentation: durable impact or kicking the can? Neurourol Urodyn. 2022; 1- 8. doi:10.1002/nau.24962