Botulinum Toxin, Endoscopy, and Mini-Invasive Treatment

Urinary incontinenceand voiding dysfunction are well represented in pediatric population, mostly as the consequence of malformations, obstetric trauma, or neurogenic conditions. Today, various mini-invasive and endoscopic procedures are available for treating these disorders, preventing severe complications to lower and upper urinary tract and providing quality of life improvement. These techniques have highly developed in the last 10 years, and most of them are supported by clear evidence of efficacy and safety and represent a standard of care. Endoscopic surgery is used to treat ureterocele, vesicoureteral reflux, urethral valves, urethral strictures, and stress urinary incontinence, which can also be cured by minimally invasive surgical approaches (pubovaginal slings). An important therapeutic option for urinary incontinencesecondary to neurogenic detrusor overactivity but also for neurogenic voiding dysfunction should be the injection of onabotulinum toxin A. In fact, phase III trials are ongoing to evaluate efficacy and safety of this treatment in children and should support the registration as “on-label” therapeutic approach, already obtained in adults, also in this population. This chapter focuses the attention on mini-invasive and endoscopic approaches to urinary incontinenceand voiding dysfunction.