{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:28:08Z","timestamp":1760059688090,"version":"build-2065373602"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,29]],"date-time":"2025-06-29T00:00:00Z","timestamp":1751155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health with Current Research funds","award":["RAP-2025-0001"],"award-info":[{"award-number":["RAP-2025-0001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Vesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer\/hyaluronic acid (Deflux(R)) injection, offers a minimally invasive alternative. The aim of this retrospective study is to evaluate the long-term effectiveness of TEM. Inclusion criteria: symptomatic II\u2013V grade VUR (also I in bilateral VUR) in NBD children with follow-up \u226512 months. Nineteen patients were enrolled, 24 ureters (grade I\u2013II: 2, grade III\u2013V: 22); 5 patients (20.8%) had bilateral VUR. Mean age at surgery: 7.6 years (1.3\u201317). No complications were reported. TEM was effective in 11 patients (57.9%), 3\/11 requiring a second TEM treatment. VUR resolution appeared in 14 ureters (58.3%), downgrading in 6 (42.9%), persistence in 4 (28.6%). Among non-responders\u2019 patients (8\/19, 42.1%), five (26.3%) required bladder augmentation (one combined with ureteral reimplantation), one (5.3%) underwent reimplantation, and two (10.5%) continued conservative management. At bladder biopsy, 11 patients (57.9%) had chronic inflammation, 8 (42.1%) showed fibrosis; no difference in success rate was recorded. All responders required repeated BTX-A injections. Mean follow-up: 3.2 years (range 1\u20134.7). In selected patients, TEM appears to be a safe and effective strategy, potentially delaying or avoiding major reconstructive surgery.<\/jats:p>","DOI":"10.3390\/toxins17070330","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T12:10:31Z","timestamp":1751285431000},"page":"330","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Effectiveness of Onabotulinum Toxin-A in a Combined Total Endoscopic Management of Pediatric Vesicoureteral Reflux in Neurogenic Bladder Dysfunction"],"prefix":"10.3390","volume":"17","author":[{"given":"Claudio","family":"Paratore","sequence":"first","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant\u2019Onofrio 4, 00165 Rome, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences, University of Genoa, Via Balbi 5, 16126 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9813-6288","authenticated-orcid":false,"given":"Chiara","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant\u2019Onofrio 4, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1386-4460","authenticated-orcid":false,"given":"Noemi","family":"Deanesi","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant\u2019Onofrio 4, 00165 Rome, Italy"},{"name":"Department of Urology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Pulvirenti","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant\u2019Onofrio 4, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Luisa","family":"Capitanucci","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant\u2019Onofrio 4, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9626-9519","authenticated-orcid":false,"given":"Giovanni","family":"Mosiello","sequence":"additional","affiliation":[{"name":"Division of Neuro-Urology, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, ERN eUROGEN Affiliated Center, Piazza di Sant\u2019Onofrio 4, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1002\/bjs.1800520304","article-title":"Vesico-ureteric reflusx in the neurogenic bladder","volume":"52","author":"Ross","year":"1965","journal-title":"Br. 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