A simplified technique for botulinum toxin injections in children with neurogenic bladder

Maria Paola Pascali, Giovanni Mosiello, Armando Marciano, Maria Luisa Capitanucci, Antonio Maria Zaccara, Mario De Gennaro

Research output: Contribution to journalArticlepeer-review


Purpose: Botulinum toxin type A has revolutionized the treatment of neurogenic bladder dysfunction. The original injection technique used a rigid cystoscope and a flexible collagen needle. To date botulinum toxin type A injection techniques have not been standardized. We present our experience in pediatric patients using a new flexible injection system. Materials and Methods: We treated 24 patients 3.8 to 17.5 years old who had neurogenic bladder dysfunction with botulinum toxin type A bladder and/or sphincter injection using a rigid cystoscope and the new N-DO™ endo-injector needle system. Another 24 patients 3.6 to 17.8 years old were treated with a 3.7Fr standard flexible needle and served as controls. Operative time, hospital stay, complications and efficacy were considered. Selection criteria and treatment were the same in the 2 groups. The 10 IU/kg dose was determined according to European Association of Urology guidelines. Results: All patients received botulinum toxin type A bladder injection while 11 patients in the endo-injector group and 5 controls also received urethral injection. In the endo-injector needle and control groups average operative time was 12.4 and 17.3 minutes for the bladder, and 5.1 and 10.1 minutes for the urethra, respectively (each p 2O, and an average bladder capacity increase of 75 and 80 ml in the endo-injector and control groups, respectively (p not significant). Conclusions: While retaining efficacy, the endo-injector needle technique appears to be more rapid than the standard procedure for botulinum toxin type A injection for neurogenic bladder dysfunction. Whether patients may be treated with sedation only remains to be clarified.

Original languageEnglish
Pages (from-to)2558-2562
Number of pages5
JournalJournal of Urology
Issue number6 SUPPL.
Publication statusPublished - Jun 2011


  • botulinum toxin type A
  • endoscopy
  • injections
  • urethra
  • urinary bladder neurogenic

ASJC Scopus subject areas

  • Urology


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