Awake botulinum injection doable in children with neurogenic bladders

A recent study suggests that awake bladder botulinum toxin injections are feasible in children with neurogenic bladder.

A team of investigators identified 48 patients with neurogenic bladders (25 male), with a total of 174 awake bladder botulinum injection encounters, in a paediatric clinic. They performed a retrospective chart review from 1 January 2018 to 30 September 2025 for paediatric patients with neurogenic bladders who received awake bladder botulinum injections.

The investigators then collected baseline characteristics, procedural details, patient’s tolerability, and subsequent awake injections.

The median age at first awake injection was 10.5 years. Of the patients, 13 had cognitive delay and six had behavioural or mental health conditions. Most of the patients (47/48, 98 percent) tolerated their first awake injection well and went through subsequent injections. The median time between injections was 5 months, with a median of three awake injections per patient.

However, 17 children discontinued awake injections due to pain or anxiety (n=5), lack of therapeutic response (n=4), having undergone urinary diversion (n=5), loss to follow-up (n=2), or unrelated death (n=1). One patient had poor tolerance due to anxiety or pain and did not receive other awake injections.

Overall, “[t]he procedure is well tolerated and can be efficiently integrated into the workflow of the outpatient clinic setting,” the investigators said.