Jon Matthew Farber, MD | Image credit: Contemporary Pediatrics

A study of the efficacy and safety of intravesical onabotulinumtoxin A (OBTA) for the treatment of nocturnal enuresis (NE) affirmed that OBTA is effective and safe in patients whose NE has not responded to conventional therapies.

In a retrospective review, investigators examined the electronic medical records of children who were evaluated for monosystematic NE by a single surgeon at a single institution. They also reviewed demographics, pertinent urologic history, and perioperative data. The 50 selected study participants had undergone at least 1 lifestyle modification and a 3-month structured bowel regimen with polyethylene glycol, and had taken at least 2 medications from different medication classes—none of which alleviated the NE.

The median age of participants was 11, with 44% female, 64% White, and a median body mass index of 22.6. All participants reported constipation, while 11 (22%) had recurrent urinary tract infections (UTIs) and 16 (32%) had encopresis.

After being prepped for outpatient surgery, including receiving general anesthesia, participants were injected with either 100 or 200 units of OBTA, as determined by a weight-based protocol. After the injections were administered, clinicians evaluated patients’ bladders for hemostasis and then emptied them completely. Patients were discharged home the same day they had the procedure.

After 9.5 months, 94% of participants reported an improvement in incontinence symptoms, with 58% experiencing complete resolution and 18 (36%) reporting greater than 50% reduction in the number of accidents. Only 3 patients (6%) had no reported improvement. These results applied equally to boys and girls, and no differences were seen between those who were administered 100 vs 200 units of OBTA.Patients whose incontinence completely resolved were less likely than their peers to have a codiagnosis of recurrent UTIs. Only 5 (10%) patients had postoperative complications, none of which were major, and included 1 episode of urinary retention and 4 UTIs.

Investigators concluded that OBTA injections are a minimally invasive option for patients with persistent NE refractory to first-line therapies.

THOUGHTS FROM DR FARBER

In the 1970s, it seemed as though steroids were being used for everything; now it’s botulism toxin. This sounds like an aggressive method of treating NE, but these patients were children for whom numerous other approaches had failed, so it seems reasonable that their families were too distressed to ride out the problem.

Click here for more from the March Mental Health issue of Contemporary Pediatrics.

Reference:

Overholt TL, Temple DM, Cohen AB, Atala A, Colaco MA, Hodges SJ. OnabotulinumA toxin injections: a novel option for management of refractory nocturnal enuresis. J Pediatr Urol. Published online October 11, 2024. doi:10.1016/j.jpurol.2024.10.01