Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals

Ranveer Vasdev; Kenneth Softness; Dylan Cahill; John Panagides; Tanya Logvinenko; Rachel Saunders; Stuart Bauer; Carlos Estrada; Hsin-Hsiao Scott Wang

doi:10.1016/j.jpurol.2024.02.012

Intradetrusor botox injection and augmentation cystoplasty trends among spina bifida patients at US freestanding children's hospitals

J Pediatr Urol. 2024 Feb 17:S1477-5131(24)00092-5. doi: 10.1016/j.jpurol.2024.02.012. Online ahead of print.

Authors

Ranveer Vasdev¹, Kenneth Softness², Dylan Cahill³, John Panagides⁴, Tanya Logvinenko⁵, Rachel Saunders⁶, Stuart Bauer⁷, Carlos Estrada⁸, Hsin-Hsiao Scott Wang⁹

Affiliations

¹ Medical School, University of Minnesota Twin Cities, 420 Delaware St SE, Minneapolis, MN, USA. Electronic address: ranveer.vasdev@gmail.com.
² Division of Urologic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Boston, Boston, MA, USA. Electronic address: Kenneth.Softness@childrens.harvard.edu.
³ Harvard Medical School, 25 Shattuck St, Boston, MA, USA. Electronic address: dylan_cahill@hms.harvard.edu.
⁴ Harvard Medical School, 25 Shattuck St, Boston, MA, USA. Electronic address: John_Panagides@hms.harvard.edu.
⁵ Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA. Electronic address: Tanya.Logvinenko@childrens.harvard.edu.
⁶ Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA. Electronic address: Rachel.Saunders@childrens.harvard.edu.
⁷ Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
⁸ Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA. Electronic address: Carlos.Estrada@childrens.harvard.edu.
⁹ Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA. Electronic address: scottwang3@gmail.com.

PMID: 38402080
DOI: 10.1016/j.jpurol.2024.02.012

Abstract

Introduction: Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida. Furthermore, there are little data regarding its use relative to bladder augmentation and patient volume on a national scale.

Objective: We sought to investigate the contemporary trends of intra-detrusor Botox injection and augment cystoplasty in free-standing children's hospitals.

Study design: We queried the Pediatric Health Information System database to identify spina bifida patients from 2016 to 2019 who underwent intra-detrusor Botox injection and augment cystoplasty based on CPT and ICD-10 codes. Total spina bifida population under care in the free-standing children's hospitals was estimated by all inpatient and ambulatory surgery encounters as denominators to calculate frequency by time for both intra-detrusor Botox injections and augmentation cystoplasty.

Results: In total, we included 1924 intra-detrusor Botox injections and 842 augmentation cystoplasties. 1413 (51.1%) patients were female. Median age at surgery was 10.0 (interquartile range 6.98-13.5) years. There was a significant increase in intra-detrusor Botox injection frequency (p < 0.001). While there was an overall decreasing, but not significant, trend for augmentation cystoplasty, there was a significant increase in this procedure during the summer months compared to the rest of the year (p < 0.001, Figure 1). Sensitivity analysis using only first intra-detrusor Botox injection per patient demonstrated similarly significant increasing trend.

Discussion: Use of intra-detrusor Botox injection for the management of neurogenic bladder has significantly increased among patients with spina bifida while augmentation cystoplasty has slightly decreased, but not significantly.

Conclusions: Over time, practice patterns for the treatments of neurogenic bladder among spina bifida children have favored minimally invasive Botox injections while augmentation cystoplasty use has not significantly changed.

Keywords: Bladder augmentation; Botox; Neurogenic bladder; Spina bifida.