Current and potential urological applications of botulinum toxin A

Abstract

Botulinum toxin subtype A (BoNT-A) is a potent neurotoxin that can selectively modulate neurotransmitter release from nerve endings, resulting in muscular paralysis. BoNT-A might also act on sensory nerves, and have an anti-inflammatory effect. In the first urological use of BoNT-A, injection into the urethral sphincters of patients with detrusor-sphincter dyssynergia resulted in a reduction of urethral resistance and improved voiding efficiency. Subsequently, intravesical BoNT-A injections have received regulatory approval for treatment of neurogenic detrusor overactivity owing to spinal cord lesions or multiple sclerosis, and idiopathic overactive bladder in adults. BoNT-A has also been widely used to treat patients with the off-label indications of neurogenic or non-neurogenic voiding dysfunction and male lower urinary tract symptoms owing to BPH and bladder-neck dysfunction. Other indications for which urologists have applied BoNT-A injections include interstitial cystitis/bladder pain syndrome, bladder oversensitivity and chronic pelvic pain syndrome. BoNT-A is currently delivered as an intravesical injection; however, use of liposome encapsulated formulations is also beginning to show some therapeutic potential.

Long‐term outcomes and risks factors for failure of intradetrusor onabotulinumtoxin A injections for the treatment of refractory neurogenic detrusor overactivity

“…For the same reason sub urothelial injection may be interesting. Finally, new technics allowing a homogenous diffusion of Botox®, without any pain, such as electromotive administration, deserve to be developed, even‐though long‐term evaluation of those techniques are still missing . .…”

Therapeutic Efficacy of onabotulinumtoxinA Delivered Using Various Approaches in Sensory Bladder Disorder

“…The brief description of probable sensory disturbances occurrence are illustrated in Figure 1. The sensory disturbances of an unstable bladder may elicit from activation of silence C-fibers due to noxious stimuli (1), stretching stretch-mediated receptors, and myofibroblasts (2), chemicals inducing urothelial signaling (3), and signals generated in a modulated motor-sensory system (4).…”

The challenge of bladder pain syndrome

“…Recent studies have additionally shown an anti-inflammatory effect and reduction of substance P in the urine following intradetrusor BTX-A injection. 19,20 Sacral nerve stimulation (SNS) is not widely available. It involves placing a lead into sacral foramen S3, connected to an implantable neurostimulator under the skin just above the sacrum.…”