Understanding factors influencing primary treatment with intradetrusor onabotulinumtoxinA versus augmentation cystoplasty in patients with spina bifida

This study determined the factors influencing the choice between intravesical onabotulinumtoxinA (Botox) and augmentation cystoplasty (AC) as the primary surgical treatment for children with neurogenic bladder caused by spina bifida. The researchers retrospectively reviewed the records of pediatric patients with myelomeningocele who underwent either primary Botox or primary AC. They identified 10 clinical decision-making factors and compared their presence between the two groups. The study found that desire for independence/continence and reduced capacity were associated with AC, while trabeculation, high end-filling pressure, rising slope, and physician-perceived hostility were more common with Botox. The findings suggest a shared decision-making approach for surgical interventions in these cases.