Botox Versus Oxybutynin as First Line Treatment for the Poorly Compliant Pediatric Neurogenic Bladder

A Pilot Study Comparing the Effects of Botulinum Toxin A and Standard Oxybutynin Therapy as First Line Treatment for the Poorly Compliant Pediatric Neurogenic Bladder

The purpose of this study is to investigate the use of Botulinum Toxin A as primary therapy for children with neurogenic bladder due to spina bifida and compare results with standard oral oxybutynin therapy. This study hopes to demonstrate that Botulinum Toxin A can maintain or improve bladder storage function without side effects associated with oxybutynin use.

Inclusion Criteria:

• Diagnosis of spina bifida and neurogenic bladder
• Performing clean intermittent catheterization (CIC)
• Taking 0.3-0.4 mg/kg/day of oxybutynin for a poorly compliant bladder
• Has not had previous bladder surgery
• Has had a urodynamic or videourodynamic study done within the last 6 months
• Upper motor neuron (UMN) type bladder demonstrated on last urodynamic study
• Urodynamic study (UDS) showing either detrusor leak point pressure >40cm H2O; 30cm below capacity <60% of total bladder capacity, 20 cm capacity <70% of bladder capacity
• Able and willing to complete CIC Diaries and Quality of Life Questionnaires
• Consent and assent given to participate in trial

Exclusion Criteria:

• History of lung disease, recurrent aspiration or severe neurological impairment which may increase risk of Botox toxicity or anesthesia
• Positive urine culture
• Known allergy to Botox