Objectives This study aimed to evaluate the distribution and intensity of intraprocedural pain during intradetrusor onabotulinumtoxinA injections by assessing differences across anatomical bladder regions and diagnostic subgroups. Specifically, the study investigated whether pain perception varied based on gender, diagnosis, and injection site in patients with idiopathic detrusor overactivity (IDO), neurogenic detrusor overactivity (NDO), and wet overactive bladder (OAB-wet). Methods In this prospective observational study, 119 adult patients who underwent intradetrusor onabotulinumtoxinA injections between March 2021 and October 2023 were included. Patients were diagnosed with IDO, NDO, or OAB-wet. All procedures were performed using flexible cystoscopy under local anesthesia with Optilube gel. A standardized 20-site injection protocol was used, including two injections on each lateral wall, five in the para-trigonal region, and 11 in randomly distributed sites on the anterior and posterior bladder walls. Patients reported their pain scores for each region using a 0-10 visual analog scale (VAS). A control group of 50 patients undergoing diagnostic flexible cystoscopy provided baseline pain scores. Two-way ANOVA was used to assess differences in pain scores based on gender, diagnosis, and anatomical region. Results A total of 119 patients (82 females, 37 males) were included, with 88 diagnosed with IDO, 28 with NDO, and 3 with OAB-wet. The mean overall VAS pain score during BoNT-A injections was 4.03 +/- 1.21, compared to 1.76 +/- 0.68 in 50 patients undergoing diagnostic flexible cystoscopy (p < 0.001). Among injection sites, mean scores were 3.78 for para-trigonal, 4.03 for lateral wall, and 3.11 for randomly distributed regions. Two-way ANOVA showed no significant differences in pain scores by gender or diagnosis, except for para-trigonal pain, which was higher in OAB-wet patients (p = 0.01). Excluding this subgroup, no significant difference remained between IDO and NDO (p = 0.06). Conclusions Intravesical onabotulinumtoxinA injections are generally well tolerated under local anesthesia, though para-trigonal injections may cause greater discomfort, particularly in patients with OAB-wet. While pain perception did not differ significantly by gender or diagnosis overall, region-specific sensitivity should be considered when planning injection techniques. These findings may help inform strategies to improve procedural comfort and support individualized treatment approaches. Trial Registration This study was not registered as a clinical trial because it was a non-randomized, observational study without prospective assignment or intervention groups, consistent with ICMJE criteria.
Aims The aim of this RCT is to compare the efficacy of sacral transcutaneous electrical nerve stimulation (TENS) with oxybutynin in children with overactive bladder (OAB), focusing on subjective & objective treatment response, adverse effects, and relapse rates.Materials and Methods In this prospective randomized controlled study, 82 children aged 5-18 years with refractory OAB were randomized to receive either sacral TENS (30 sessions; 20 min each (10 Hz) daily; for 4 weeks) or oral oxybutynin (0.2 mg/kg/day for 4 weeks). Outcomes were assessed using subjective response categories based on bladder diaries and objective measures including the Overactive Bladder Index (OABI) and Dysfunctional Voiding Symptom Score (DVSS). Adverse effects and relapse during 6-12 months of follow-up were recorded.Results There was no significant difference between age/sex distributions between the groups. Median follow-up was 9 (6-12) months. Complete response was significantly higher with TENS than oxybutynin (68.3% vs. 31.7%; OR 4.63, 95% CI 1.8-11.7; p = 0.001). Mean improvement in OABI (4.6 +/- 1.4 vs. 3.7 +/- 1.0; p = 0.001) and DVSS (8.8 +/- 1.5 vs. 5.7 +/- 1.3; p = 0.001) favored TENS. Adverse effects (4.9% vs. 46.3%) and relapse rates (7.3% vs. 29.3%) were significantly lower with TENS.Conclusion Sacral TENS was associated with higher response rates and fewer adverse effects than oxybutynin in this cohort supporting its role as an effective and well-tolerated therapeutic option for pediatric OAB. Further larger trials are warranted.
Objective To compare unsafe storage-pressure urodynamic findings in children with radiological suspicion or confirmation of tethered spinal cord and in clinically referred children without radiological tethering.Materials and Methods This single-center retrospective comparative study included children aged 2-18 years who underwent urodynamic testing between October 2024 and December 2025 and had available spinal magnetic resonance imaging. Of 172 children assessed, 52 were excluded because spinal MRI was unavailable. The final cohort included 120 children: 60 with radiological tethering and 60 without tethering. The primary outcome was an unsafe storage-pressure urodynamic pattern. Post-void residual urine was excluded from the primary composite outcome and analyzed separately.Results Age and sex were comparable between groups. Unsafe storage-pressure urodynamics were more frequent in the radiological tethered cord group than in the non-tethered comparison group (48.3% vs. 21.7%, p = 0.003). Low compliance, elevated end-filling pressure, high-pressure detrusor overactivity, detrusor-sphincter dyssynergia, and increased post-void residual urine were also more common. MRI and urodynamic risk were not fully concordant: 51.7% of children with radiological tethering had safe storage-pressure urodynamics, whereas 21.7% without tethering had unsafe findings. Radiological tethering alone demonstrated a sensitivity of 69.0%, specificity of 60.3%, positive predictive value of 48.3%, and negative predictive value of 78.3% for unsafe storage-pressure urodynamics. In multivariable analysis, radiological tethering, increased post-void residual urine, and hydronephrosis were independently associated with unsafe storage-pressure urodynamics.Conclusions Radiological tethering was associated with unsafe storage-pressure urodynamic findings, but MRI alone did not define functional bladder safety. Increased post-void residual urine and hydronephrosis may identify children at higher risk; however, these findings are hypothesis-generating and do not establish a validated pathway for safely withholding urodynamic testing.
