Intravesical botox as an effective therapy for giggle incontinence in children

Giggle incontinence is a bladder storage disorder characterized by uncontrolled voiding during or immediately after laughter. Many children are refractory to available therapies or experience considerable side-effects. This study aimed to determine the efficacy of intravesical Botox injections in the management of giggle incontinence. A retrospective review of all children who received 200iU intravesical botulinum toxin-A for giggle incontinence over twelve years was performed. All children experienced complete bladder emptying during or immediately after laughter as their primary complaint, with or without a related voiding disorder. Outcomes were characterised as: “no response” (0–49% reduction), “partial response” (50–99% reduction), or “complete response” (100% reduction). A total 34 procedures (range: 1–5) in 17 children were included. Median age at first treatment was 11 years (range: 6-17y). Complete response occurred in 65% of patients and partial response in 18%. Of those who experienced complete response, 55% (6/11) had no relapse of symptoms with a median duration of follow-up of 5 years (IQR 3.5-6.5y). Giggle incontinence is a rare but significant condition with marked impact on quality of life. This is the first study describing the use of intravesical Botox injection in this population, demonstrating safety and efficacy with a sustained response to treatment in many patients.