Onabotulinum Toxin A Intradetrusor Injections in Children with Neurogenic Lower Urinary Tract Dysfunction: Long-Term Histological Effects on the Bladder Wall
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Published:2023-04-27
Issue:5
Volume:11
Page:1300
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ISSN:2227-9059
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Container-title:Biomedicines
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language:en
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Short-container-title:Biomedicines
Author:
Pellegrino Chiara1ORCID, Forlini Valentina12, Lena Federica12ORCID, Capitanucci Maria Luisa1, Diomedi Camassei Francesca3, Castelli Enrico4, Mosiello Giovanni1ORCID
Affiliation:
1. Division of Neuro-Urology, Bambino Gesù Children’s Hospital, Piazza di Sant’Onofrio, 4, 00165 ERN eUROGEN Affiliated Center, 00118 Rome, Italy 2. Pediatric Surgery Division, University of Genova, via Balbi 5, 16126 Genoa, Italy 3. Pathology Unit, Department of Laboratories, Bambino Gesù Pediatric Hospital IRCCS, 00118 Rome, Italy 4. Pediatric Neurorehabilitation, Bambino Gesù Children’s Hospital, 00118 Rome, Italy
Abstract
Background: In the last twenty-five years, Onabotulinum Toxin A (BTX-A) has gained increasing popularity for neurogenic lower urinary tract dysfunction (NLUTD) treatment. To maintain its efficacy, repeated BTX-A intradetrusor injections are required over time, with unknown effects on the bladder wall in children. The aim of this paper is to report long-term effects on the bladder wall in children treated with BTX-A. Methods: Children with NLUTD not responsive to anticholinergics were treated with BTX-A, according to our protocol, with bladder wall control using endoscopic cold-cup biopsy. Specimens were evaluated considering edema, chronic inflammation, and fibrosis. Results: Of the 230 patients treated from 1997 to 2022, we considered only specimens obtained in patients who had received ≥5 treatments (36 children), considered as the threshold to evaluate clinical effectiveness on long-term treatment with BTX-A. Most of them had congenital NLUTD (25 patients) and detrusor overactivity (27 patients). In all, increased edema and chronic inflammation with reduced fibrosis over time was reported; these data were not statistically significant. No difference was observed between patients with congenital and acquired diseases. Conclusions: Repeated intradetrusor BTX-A injections are not related to significant histological alterations in children, similarly with adults, and repeated injections could be considered safe.
Subject
General Biochemistry, Genetics and Molecular Biology,Medicine (miscellaneous)
Reference31 articles.
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