Response to Treatment with Botulinum Neurotoxin A (BoNT-A) in Children and Adolescents with Neurogenic Lower Urinary Tract Dysfunction and Idiopathic Overactive Bladder: A Systematic Review and Meta-Analysis
Andrea Panunzio,
Rossella Orlando,
Giovanni Mazzucato,
Sonia Costantino,
Giulia Marafioti Patuzzo,
Clara Cerrato,
Rita De Mitri,
Vincenzo Pagliarulo,
Alessandro Tafuri,
Antonio Benito Porcaro,
Alessandro Antonelli,
Riccardo Giuseppe Bertolo,
Luca Giacomello,
Maria Angela Cerruto
Affiliations
Andrea Panunzio
Department of Urology, “Vito Fazzi” Hospital, Piazza Filippo Muratore 1, 73100 Lecce, Italy
Rossella Orlando
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Giovanni Mazzucato
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Sonia Costantino
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Giulia Marafioti Patuzzo
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Clara Cerrato
University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
Rita De Mitri
Department of Urology, “Vito Fazzi” Hospital, Piazza Filippo Muratore 1, 73100 Lecce, Italy
Vincenzo Pagliarulo
Department of Urology, “Vito Fazzi” Hospital, Piazza Filippo Muratore 1, 73100 Lecce, Italy
Alessandro Tafuri
Department of Urology, “Vito Fazzi” Hospital, Piazza Filippo Muratore 1, 73100 Lecce, Italy
Antonio Benito Porcaro
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Alessandro Antonelli
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Riccardo Giuseppe Bertolo
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Luca Giacomello
Paediatric Surgery Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Maria Angela Cerruto
Urology Clinic, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Aristide Stefani 1, 37126 Verona, Italy
Introduction: Botulinum neurotoxin A (BoNT-A) is a treatment option for neurogenic lower urinary tract dysfunctions (NLUTD) and idiopathic overactive bladder (OAB) in adults. Recently, its use has gained popularity in paediatric urology. Transitional urology deals with adolescents affected by congenital urological issues, who mature into adulthood. The aim of this systematic review was to update the current knowledge on the use of BoNT-A in children and adolescents. Methods: A comprehensive search in PubMed, Scopus, and Web of Science databases was performed from articles published up to September 2024. Both prospective and retrospective single-cohort or comparative studies evaluating outcomes of interest were included. These consisted of the amelioration of urinary incontinence (UI), continence rates, improvement of urodynamic parameters (maximum detrusor pressure during voiding, maximum bladder capacity, and bladder compliance), and type and prevalence of adverse/side effects. Qualitative and quantitative data syntheses were provided. Moderators and meta-regression analyses were carried out as well. Results: Forty-one full-text manuscripts were selected of which 26 focused on children with NLUTD, 13 on idiopathic OAB, and two on both conditions. Overall, 1521 patients were included of whom 715 were male, 646 female, and 160 of unknown sex. Mean age varied between 5.6 and 15.6 years. No studies specifically focused on transitional urology, despite patients up to at least 17 years of age being included. Several differences existed in design, type, dose, way of administration, outcomes measured and follow-up time; however, all studies independently showed an improvement of UI and urodynamic parameters with no major side/adverse events. Pooled analysis showed a mean rate of improvement in UI scores/episodes of 75.87% within a period of 3–6 months following BoNT-A treatment. Meta-regression analyses demonstrated a significant correlation between dryness rate and both patients’ age (negative) and bladder compliance (positive). Conclusions: Several uncontrolled or comparative studies provided significative evidence of the clinical benefit and safety of BoNT-A administration in children in terms of UI relief and improvement of urodynamic parameters, with neurogenic aetiologies being the most investigated conditions. A reduced bladder compliance was identified as one of the potential predictors of poor response to BoNT-A. Moreover, the earlier the treatment was started the higher the success rate that was reached in terms of dryness/urinary continence achievement.
