O1038: Characterization of Intradetrusor Onabotulinumtoxina Use in Spina Bifida Patients over Time: Where Are They Now?

Background: Intradetrusor onobotulinumtoxinA (Botox) injection has become a common tool in bladder management of children with spina bifida (SB). However, whether Botox is a viable option for long term management or part of a stepwise approach aiming to delay augmentation cystoplasty (AC) remains unclear. We sought to characterize changes in Botox use over time in SB patients and to describe current bladder management of patients with long-term follow up. We hypothesized age at first Botox and number of patients progressing to reconstructive surgery have decreased over time.

Methods: Patients with SB who underwent Botox between 2013-2022 were retrospectively characterized. To evaluate a change in practice over time, patients who had first injection from 2013-2015 and from 2018-202 were compared. To evaluate long term outcomes, details of current bladder management for the early cohort were recorded. Descriptive statistics are reported using parametric methods.

Results: 218 Botox cases in 87 SB patients were identified. 24 underwent first Botox injection in 2013-2015, and 31 underwent first injection in 2018-2020, for 8 patients/year in the early cohort and 10 patients/year in the recent group. Mean age at Botox was 9.8 years (y) (range 3-17) in the early group and 9y (range 1-19y) (p=0.51) in the recent group. In the early group, 10 (40%) patients proceeded to reconstructive surgery within a mean time of 1.5y (range 0.2-4.9y). In the recent group, 6 (19%) patients proceeded to reconstructive surgery within a mean time of 1.7y (range 1.1-2.2y). 8 (34.7%) patients continued regular Botox in the early group compared to 9 (37.5%) patients in the recent group. Mean follow-up from first Botox was 7.2y (range 1.7-8.9y) and 3.3y (range 1.2-4.4y) in the early and recent groups, respectively. Long-term outcomes of the early group are summarized in Figure 1. For patients who progressed to reconstructive surgery, 8/10 had elevated bladder pressures on urodynamics. 5/8 patients still getting Botox also remained on scheduled anticholinergic medications. No patients had evidence of worsening upper tract function on last follow-up.

Conclusion: Botox use mildly increased over time, but age of Botox patients did not decrease as hypothesized. Progression to AC did decrease with time. Most patients are not receiving Botox long-term, but only a portion of these patients required reconstructive operations. Transition to injection without anesthesia also appears feasible.