Botulinum toxin for treating overactive bladder in men: A systematic review

Abstract

Purpose We sought to systematically review the literature on the use of botulinum toxin (BTX‐A) injections in the bladder to treat overactive bladder (OAB) in men. Materials and methods A systematic review was performed to identify clinical trials on efficacy and safety of BTX‐A injections in the detrusor for treatment of OAB in men published from inception to October 2020. Quality assessment was performed using the Cochrane Collaboration's tool for assessing risk of bias and study characteristics were extracted by two reviewers independently. Results After screening 75 abstracts, 12 trials were included in the qualitative synthesis, of which 6 were conducted exclusively in men (mean age: 66.7 years). Only two were randomized controlled studies and the remaining were observational studies, mostly case series. Total number of participants in each study ranged from 28 to 146. Therapeutic response to intravesical BTX‐A injection was assessed differently across the studies, which used quality‐of‐life symptom questionnaires and voiding diary parameters. Urodynamics findings were reported separately for men before and after intravesical injection of BTX‐A in two studies only. Pooling of outcome data was possible with adverse events reported after BTX‐A by seven studies, which showed urinary tract infection, urinary retention, increased postvoid residual, de novo interstitial cystitis, and hematuria rates of 29.8%, 20.0%, 37.3%, 28.3%, and 12.4%, respectively. Conclusions Limited information regarding the efficacy and safety of BTX‐A bladder injections for male OAB from relatively low evidence is available. Further research is needed to better understand the risk‐benefit profile of BTX‐A in the male population.

Rac1 as a Target to Treat Dysfunctions and Cancer of the Bladder

“…The pharmacotherapy of OAB relies essentially on the use of two β 3 -adrenergic agonists: vibegron ( Gemtesa ® , FDA-approved in 2020) and mirabegron ( Myrbetriq ® , FDA-approved in 2012) with a comparable limited efficacy, even if vibegron, with less side effect on blood pressure, is often preferred to mirabegron [ 5 , 6 , 7 , 8 ]. A few other options are available, including the use of botulinum toxin A, neuromodulation with implantable devices, and laser treatment but their efficacy is limited [ 9 , 10 , 11 ]. The search for novel treatment modalities and drugs continues.…”

Intravesical Injection of Botulinum Toxin Type A in Patients with Refractory Overactive Bladder—Results between Young and Elderly Populations, and Factors Associated with Unfavorable Outcomes

“…UTI is another common but frustrating unfavorable outcome after intravesical BoNT-A injections [ 55 ]. A recent systemic review revealed that the prevalence rate of UTI after intravesical BoNT-A injection for treating OAB is approximately 29.8% [ 56 ]. Both storage and emptying dysfunction have been proposed to impact UTI recurrence [ 57 , 58 ].…”

Clinical Application of Botulinum Neurotoxin in Lower-Urinary-Tract Diseases and Dysfunctions: Where Are We Now and What More Can We Do?

“…The most common and frustrating adverse events after Botox injection for OAB are UTI and dysuria [ 33 ]. In patients with OAB, previous UTI is the strongest predictor of UTI after Botox injection.…”

“…Current application of botulinum toxin A on lower-urinary-tract diseases or dysfunctions. ,[7][8][9][10][11][12]15,16,18,19,33,[35][36][37][38] …”