Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction
Vesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer/hyaluronic acid (Deflux<sup>(R)</sup>) injection,...
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MDPI AG
2025-06-01
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| author | Claudio Paratore Chiara Pellegrino Noemi Deanesi Rebecca Pulvirenti Maria Luisa Capitanucci Giovanni Mosiello |
| author_facet | Claudio Paratore Chiara Pellegrino Noemi Deanesi Rebecca Pulvirenti Maria Luisa Capitanucci Giovanni Mosiello |
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| description | Vesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer/hyaluronic acid (Deflux<sup>(R)</sup>) injection, offers a minimally invasive alternative. The aim of this retrospective study is to evaluate the long-term effectiveness of TEM. Inclusion criteria: symptomatic II–V grade VUR (also I in bilateral VUR) in NBD children with follow-up ≥12 months. Nineteen patients were enrolled, 24 ureters (grade I–II: 2, grade III–V: 22); 5 patients (20.8%) had bilateral VUR. Mean age at surgery: 7.6 years (1.3–17). No complications were reported. TEM was effective in 11 patients (57.9%), 3/11 requiring a second TEM treatment. VUR resolution appeared in 14 ureters (58.3%), downgrading in 6 (42.9%), persistence in 4 (28.6%). Among non-responders’ patients (8/19, 42.1%), five (26.3%) required bladder augmentation (one combined with ureteral reimplantation), one (5.3%) underwent reimplantation, and two (10.5%) continued conservative management. At bladder biopsy, 11 patients (57.9%) had chronic inflammation, 8 (42.1%) showed fibrosis; no difference in success rate was recorded. All responders required repeated BTX-A injections. Mean follow-up: 3.2 years (range 1–4.7). In selected patients, TEM appears to be a safe and effective strategy, potentially delaying or avoiding major reconstructive surgery. |
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| publishDate | 2025-06-01 |
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| spelling | doaj-art-c3e9d906c7dc43cf9a49b528a1e238072025-08-20T03:08:02ZengMDPI AGToxins2072-66512025-06-0117733010.3390/toxins17070330Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder DysfunctionClaudio Paratore0Chiara Pellegrino1Noemi Deanesi2Rebecca Pulvirenti3Maria Luisa Capitanucci4Giovanni Mosiello5Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant’Onofrio 4, 00165 Rome, ItalyDivision of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant’Onofrio 4, 00165 Rome, ItalyDivision of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant’Onofrio 4, 00165 Rome, ItalyDivision of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant’Onofrio 4, 00165 Rome, ItalyDivision of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant’Onofrio 4, 00165 Rome, ItalyDivision of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant’Onofrio 4, 00165 Rome, ItalyVesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer/hyaluronic acid (Deflux<sup>(R)</sup>) injection, offers a minimally invasive alternative. The aim of this retrospective study is to evaluate the long-term effectiveness of TEM. Inclusion criteria: symptomatic II–V grade VUR (also I in bilateral VUR) in NBD children with follow-up ≥12 months. Nineteen patients were enrolled, 24 ureters (grade I–II: 2, grade III–V: 22); 5 patients (20.8%) had bilateral VUR. Mean age at surgery: 7.6 years (1.3–17). No complications were reported. TEM was effective in 11 patients (57.9%), 3/11 requiring a second TEM treatment. VUR resolution appeared in 14 ureters (58.3%), downgrading in 6 (42.9%), persistence in 4 (28.6%). Among non-responders’ patients (8/19, 42.1%), five (26.3%) required bladder augmentation (one combined with ureteral reimplantation), one (5.3%) underwent reimplantation, and two (10.5%) continued conservative management. At bladder biopsy, 11 patients (57.9%) had chronic inflammation, 8 (42.1%) showed fibrosis; no difference in success rate was recorded. All responders required repeated BTX-A injections. Mean follow-up: 3.2 years (range 1–4.7). In selected patients, TEM appears to be a safe and effective strategy, potentially delaying or avoiding major reconstructive surgery.https://www.mdpi.com/2072-6651/17/7/330vesicoureteral refluxneurogenic bladder dysfunctionendoscopic managementminimally invasiveOnabotulinum Toxin-ADeflux |
| spellingShingle | Claudio Paratore Chiara Pellegrino Noemi Deanesi Rebecca Pulvirenti Maria Luisa Capitanucci Giovanni Mosiello Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction Toxins vesicoureteral reflux neurogenic bladder dysfunction endoscopic management minimally invasive Onabotulinum Toxin-A Deflux |
| title | Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction |
| title_full | Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction |
| title_fullStr | Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction |
| title_full_unstemmed | Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction |
| title_short | Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction |
| title_sort | long term effectiveness of onabotulinum toxin a in a combined total endoscopic management of pediatric vesicoureteral reflux in neurogenic bladder dysfunction |
| topic | vesicoureteral reflux neurogenic bladder dysfunction endoscopic management minimally invasive Onabotulinum Toxin-A Deflux |
| url | https://www.mdpi.com/2072-6651/17/7/330 |
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