Botulinum toxin A for the treatment of neurogenic bladder in children: a systematic review and meta-analysis.

IF 1.5 4区医学 Q3 SURGERY

ANZ Journal of Surgery Pub Date : 2024-11-11 DOI:10.1111/ans.19309

Guorong He, Nan Shen, Shaoguang Feng

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引用次数: 0

Abstract

Purpose: We performed a systematic review and meta-analysis to assess the current evidence on the effectiveness of botulinum toxin A (BTX-A) intradetrusor injections in paediatric NB patients who are resistant to antimuscarinic treatments.

Methods: A study was carried out on PubMed, Medline, and Embase with the search terms: ('neurogenic bladder' OR 'myelomeningocele') AND 'toxin' AND ('children' OR 'paediatric'). The PICOS framework guided the search strategy and selection of studies in line with the PRISMA guidelines. Research involving original data that examined BTX-A in paediatric patients with NB was included. Studies were independently chosen and data were extracted by two reviewers.

Results: Nineteen studies (one randomized controlled trial, six prospective studies, and 12 retrospective studies) that investigated the clinical application of BTX-A injections in children with NB were identified. None of the studies compared BTX-A to a placebo, and most lacked a control group. Results showed that maximal cystometric capacity increased by an average of 97.7 mL (34.1-162% increase) (95% confidence interval [CI] 59.6 to 135.8), while maximal detrusor pressure decreased by 25.2 cm H₂O (95% CI -39.7 to -10.7). Bladder compliance improved by 5.3 mL/cm H₂O (95% CI 2.9 to 7.8). After treatment, the average incontinence resolution rate among patients was 73.4%. Urinary tract infections were reported by 77 patients (13.6%).

Conclusions: BTX-A administered intradetrusorally enhances cystometric capacity, compliance, and maximum neurogenic detrusor overactivity in paediatric patients suffering from neurogenic bladder. Nonetheless, this conclusion lacks support from studies with a high level of evidence.

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治疗儿童神经源性膀胱的 A 型肉毒杆菌毒素：系统综述和荟萃分析。

目的：我们进行了一项系统性综述和荟萃分析，以评估目前关于 A 型肉毒毒素（BTX-A）尿道内注射对抗心绞痛治疗耐药的儿科 NB 患者的有效性的证据：在PubMed、Medline和Embase上进行了一项研究，检索词为：（"神经源性膀胱 "或 "髓样膀胱"）、"毒素 "和（"儿童 "或 "儿科"）。根据 PRISMA 指南，PICOS 框架指导了检索策略和研究的选择。涉及原始数据、研究 BTX-A 在儿科 NB 患者中的应用的研究均被纳入。研究由两名审稿人独立选择并提取数据：结果：共发现 19 项研究（1 项随机对照试验、6 项前瞻性研究和 12 项回顾性研究）调查了 BTX-A 注射在儿童 NB 患者中的临床应用。其中没有一项研究将 BTX-A 与安慰剂进行了比较，而且大多数研究缺乏对照组。结果显示，最大膀胱容量平均增加了97.7毫升（增加34.1%-162%）（95%置信区间[CI] 59.6至135.8），而最大逼尿肌压力降低了25.2厘米水深（95%置信区间-39.7至-10.7）。膀胱顺应性提高了 5.3 mL/cm H2O（95% CI 2.9 至 7.8）。治疗后，患者尿失禁的平均解决率为 73.4%。77名患者（13.6%）报告了尿路感染：结论：BTX-A 经尿道内给药可增强神经源性膀胱儿科患者的膀胱容量、顺应性和最大神经源性逼尿肌过度活动。尽管如此，这一结论仍缺乏高水平研究的支持。

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

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.