BACKGROUNDBy comparing the bladder function evaluated by urodynamic study (UDS)before and after botulinum toxin A (BTX-A) injection in children with refractory wet overactive bladder (OAB-wet), we investigated the efficacy and safety of intravesical BTX-A injection in children with refractory OAB-wet, and the factors that may predict the efficacy of BTX-A injection.METHODSFrom January 2021 to March 2024, a total of 35 children with OAB-wet, refractory to urotherapy and drug treatments, were enrolled in this retrospective study in First Affiliated Hospital of Zhengzhou University. All patients received 100U BTX-A injection into the bladder wall. The patient's medical records, clinical symptoms and urodynamic studies within 1 week before and 3 months after BTX-A injection were analyzed. The global response assessment (GRA) score of ≥1 after injection was defined as effective treatment. Perioperative and postoperative adverse events were also recorded. According to the postoperative GRA score at 3 months, the patients were divided into effective group and ineffective group. The UDS parameters and lower urinary tract symptoms after BTX-A injection were compared between the two groups.RESULTS A total of 35 children (average age, 12.3±4.2 years), including 13 males (37.1%) and 22 females (62.9%), were enrolled in the study. After BTX-A injection, both bladder compliance and measured/expected bladder capacity increased significantly (P<0.001). Overactive bladder symptom score (OABSS) and incontinence quality of life questionnaire (I-QOL) score significantly improveed (P<0.001). Most patients (77.1%) were satisfied with BTX-A injection. The main adverse event during the follow-up was temporary increase in post-voided residual (PVR) after injecting BTX-A (P=0.011). A significant differences were found between effective group (27 cases) and ineffective group (8 cases) in age (13.00+4.32 vs. 10.00+2.67, T = 2.383) and in postoperative bladder compliance (15.48+7.41 vs. 6.50+5.12, T = 3.192)(P<0.05). No significant differences were found between the two groups in gender(male) [9 (33.3%) vs. 4 (50%)], central nerve injury(spina bifida, spinal surgery, etc.) [19 (70.4%) vs. 6 (75%)], transient urinary retention [9 (33.3%) vs. 2 (25%)] (P > 0.05).CONCLUSIONSIntravesical BTX-A injection is a useful and safe tool in treating refractory OAB-wet in children. However, BTX-A injection should be carefully selected for children with OAB, especially in cases with a large amount of PVR. Different nerve injuries have no effect on the effectiveness of BTX-A and does not increase the incidence of adverse reactions.
