Softness KA, Thaker H, Theva D, et al. - Botox improved detrusor overactivity (DO), detrusor pressures, compliance, incontinence, and hydronephrosis in 38% of children with refractory neurogenic bladder (NGB). Patients are classified based on their baseline urodynamic parameters to determine who will benefit the most and how much improvement they can expect. Even so, certain patients will require more invasive procedures like augmentation cystoplasty. For a subset of children with refractory NGB, at least one Botox injection should be considered, along with appropriate expectations counselling.

• This study included children who received Botox for refractory NGB from a single academic center between 2008 and 2019.

• Thirteen (38.2%) of the 34 patients who got Botox had a good reaction after the first injection, with an increase in capacity of 35% of predicted capacity for age, compared to only 9% in those who did not respond clinically.

• When patients were separated into groups based on their baseline urodynamic characteristics, high-pressure (Pdetmax > 20 cm H ₂O) patients improved their compliance much more than low-pressure patients.

• Low compliance patients (< 10 ml/cm H ₂O) saw a 3.08 ml/cm H ₂O improvement in compliance, compared with no change in the high compliance group.

• Finally, when compared with high-capacity patients, low-capacity patients (< 50% of expected CC) experienced significant improvements in capacity and compliance.

• Both clinical responders and non-responders showed improvement in DO.