To investigate the effectiveness of botulinum toxin type A injections to external sphincter and bladder in pediatric patients who has neuropathic bladder.

In our clinic, pediatric patients diagnosed with neuropathic lower urinary tract dysfunction and who had undergone botulinum toxin type A injection were analyzed retrospectively. Patients' age, functional bladder capacity, compliance, residual urine, frequency of clean intermittant catheterization(CIC),incontinence episodes, urodynamic data and the frequency of infections were evaluated retrospectively.

The average age of six girls and six boys of 12 pediatric patients were determined as 10 ± 4,8 years. Incontinence episodes were calculated as 0,75 ± 0,46 / day. Botulinum toxin type A were injected only into bladder in seven patients and to both bladder and external sphincter in five patients. Average amount of injected botulinum toxin type A into bladder was 147 ± 60 Units and to external sphincter was 55 ± 10 Units.Mean follow‐up of period was 11,2 ± 8,9 months. 11 patients received anticholinergic therapy for 24 ± 18 months preoperatively.

Daily incontinence episodes decrease to 0,56 ± 0,52 /day ( p:0,003 ). Bladder capacity was increased from 147 ± 86 mL to 203 ± 103 mL ( p:0,007 ). Residual urine volume was decreased from 52 ± 42 mL to 44 ± 40 mL ( p:0,4 ), in seven patients who didin’t do CIC. Peak flow rate was increased from 14,1 ± 10 mL/sec to 17,1 ± 13 mL/sec (p:0,3). The average flow rate was increased from 5,5 ± 4,2 mL/sec to 7,8 ± 5,7 mL/sec(p:0,1).Average preoperative compliance was increased from 4,1 ± 3,1 cm/H2O to 6,0 ± 4,3 cm/H2O ( p:0,036 ). Two of the five patients who had incontinence between CIC remained dry after injection. Four patients with urinary infections before injection have no infection in postoperative folow‐up. It was more significant improvement about compliance in patients with neurogenic overactive bladder than in patients with fibrotic bladder (p:0,042). Improvement in compliance was found to significantly reduce incontinence between CIC ( p:0,025 ) ( r:‐0,86).Subureteral bulking agent was injected in three of the four patients with vesicoureteral reflux.Reflux was continued in all patients in the postoperative period. There was no postoperative complication according to Clavien classification

Injection of botulinum toxin type A is a safe and effective treatment modality. Botulinumtoxin Type A injection provide to reduction in incontinence episodes and increasing the compliance and capacity of bladder in pediatric patient with neuropathic lower urinary tract dysfunction.