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Botulinum toxin A detrusor injections reduce muscular M2, P2X2 and P2X3 receptors in children and adolescents with neurogenic detrusor overactivity

Study Design, Materials and Methods A bladder augmentation became necessary in 9 children and adolescents (7m, 2f, median age 12 years) with conservatively treated neurogenic detrusor overactivity. 6 children had previously received between 1 and 8 ( 4) BoNT/A detrusor injections, the last one always being 300 U Botox ® ; however, the detrusor pressure values could not be maintained at tolerable values anymore with this therapy due to a low-compliance bladder. The last injection session had been completed 3 months previously (1.5 3.5) on average. 3 patients had never received such a therapy (controls). The bladder dome resections were placed into a 4% buffered paraformaldehyde solution; afterwards, a specific receptor analysis (muscarinic M2 and M3, purinergic P2X1, P2X2, P2X3) via confocal immunofluorescence was performed and the nerve fiber density was analyzed via light-microscopic DAB-immunohistochemical staining.