Third-Line Therapeutic Interventions for Non-Neurogenic Bladder Dysfunction in Children.

IF 2.5 2区医学 Q2 UROLOGY & NEPHROLOGY

Current Urology Reports Pub Date : 2024-12-01 Epub Date: 2024-08-02 DOI:10.1007/s11934-024-01227-3

Alyssa M Lombardo, Seth A Alpert

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Abstract

Purpose of review: The aim of this article is to review considerations and efficacy of third-line treatments for pediatric non-neurogenic bladder dysfunction, including Botulinum toxin A (BoTNA), Posterior Tibial Nerve Stimulation (PTNS), and Sacral Neuromodulation (SNM).

Recent findings: Federal Drug Administration approval for use of beta-3-agonists in overactive detrusor activity in pediatric patients may provide an additional step prior to third-line therapies. New long-term data on pediatric SNM efficacy, complications, and revision rates will provide valuable information for counseling families. BoTNA offers a safe and efficacious treatment to decrease detrusor contractility and improve bladder capacity but is limited by the half-life of BoNTA agent. Percutaneous or transcutaneous PTNS offers improved voided volumes or cure in some patients but is time-intensive. SNM can be utilized in a variety of LUTD pathology with high success rate and cure but should consider cumulative anesthetic and fluoroscopic exposures for battery replacements and re-positioning for patient growth.

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儿童非神经源性膀胱功能障碍的三线治疗干预。

综述目的：本文旨在综述治疗小儿非神经源性膀胱功能障碍的三线疗法的注意事项和疗效，包括 A 型肉毒杆菌毒素 (BoTNA)、胫后神经刺激 (PTNS) 和骶神经调控 (SNM)：最近的研究结果：美国联邦药品管理局批准使用β-3-激动剂治疗儿童患者的过度逼尿肌活动，这为三线疗法提供了一个新的步骤。关于小儿SNM疗效、并发症和翻修率的新的长期数据将为咨询家庭提供有价值的信息。BoTNA 是一种安全有效的治疗方法，可降低逼尿肌收缩力并改善膀胱容量，但受 BoNTA 制剂半衰期的限制。经皮或经皮 PTNS 可改善部分患者的排尿量或治愈，但耗时较长。SNM可用于各种LUTD病理，成功率和治愈率都很高，但应考虑到更换电池和重新定位以适应患者生长所需的累积麻醉和透视暴露。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Urology Reports UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

3.80%

发文量

期刊介绍： This journal intends to review the most important, recently published findings in the field of urology. By providing clear, insightful, balanced contributions by international experts, the journal elucidates current and emerging approaches to the care and prevention of urologic diseases and conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as benign prostatic hyperplasia, erectile dysfunction, female urology, and kidney disease. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.