Botulinum toxin injections for paediatric incontinence
Bibliographic record
Abstract
PURPOSE OF REVIEW: This review highlights a recent innovation in the medical treatment of children with neurogenic detrusor overactivity. Anticholinergics are usually the main way to treat bladder overactivity. Side effects and lack of efficacy are the two main causes for considering alternative treatment. Up to recently, invasive surgery, mainly bladder augmentation, was the only available treatment for these intractable bladders. Here, we report on botulinum A toxin injection as an alternative to surgery in children with neurogenic detrusor overactivity. RECENT FINDINGS: There are only four published articles on the use of botulinum A toxin in children with neurogenic detrusor overactivity. However, an increasing number of reports indicate clinical benefit and a good safety profile of botulinum A toxin in neurogenic and idiopathic detrusor overactivity. Extrapolation of the data published in adults treated with botulinum A toxin injections and understanding the mechanism of action on the detrusor muscle are worthwhile to encourage paediatric physicians to propose this option to their patients. Furthermore, the literature does not seem to warn against drug resistance or ultrastructural changes of the detrusor after repeated injection. SUMMARY: Botulinum A toxin appears to be a reasonable alternative to surgery in the management of intractable overactive bladder in children. However, studies of the delivery method, site of injection, dose and long-term follow-up are required to confirm the good safety profile/clinical benefit of this new, minimally invasive approach.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".