Experience with botulinum toxin type A in the treatment of neurogenic detrusor overactivity in clinical practice

Abstract

Control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous system. Neurogenic lower urinary tract dysfunction (LUTD) is a widespread chronic illness that impairs millions of people worldwide. Neurogenic LUTD has a major impact on quality of life, affecting emotional, social, sexual, occupational and physical aspects of daily life, and in addition to the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system. First-line treatment for neurogenic LUTD includes antimuscarinics and some form of catheterization, preferably intermittent self-catheterization. However, the treatment effect is often unsatisfactory, so that other options have to be considered. Moreover, neurogenic LUTD is a challenge because all available treatment modalities (i.e. conservative, minimally invasive and invasive therapies) may fail. In recent years, botulinum neurotoxin type A (BoNT/A) treatment has been shown to be an effective pharmacological therapy option in patients refractory to antimuscarinic and neurogenic detrusor overactivity (NDO). Several studies have shown that BoNT/A injection significantly reduces detrusor muscle overactivity. Also BoNT/A treatment of NDO has revealed a significant improvement of lower urinary tract function with regard to reduced urinary incontinence, reduced detrusor pressure, increased bladder capacity and improved quality of life in NDO.

Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies

“…It is an effective alternative for patients with NDO who fail pharmacotherapy 40,85 and is safe and effective in catheterized refractory NDO patients. 9,[86][87][88][89] The European Association of Urology guidelines note that "botulinum toxin injection in the detrusor is the most effective minimally Neurogenic detrusor overactivity S347…”

Clinical Pathways of Third-Line Treatment of Overactive Bladder in the Elderly

“…BoNTA have been studied as intradetrusor injection for the treatment of detrusor overactivity since 2000 [26]. Although the mechanism of action of BoNTA in urinary bladder has already described in details [27], new information becomes available every year.…”

Experimental Comparative Effects of Botulinum Toxin A between Subtypes A1 and A2 in Movement Disorders in Rats

“…Several species of botulinum neurotoxin are known to act on cholinergic terminals of the peripheral neuromuscular junction and the central nervous system (CNS) [3][4][5]. NTXs cause robust inhibition of the voluntary nervous circuits by blocking the release of acetylcholine (ACh) [6].…”

“…Recent studies investigated the direct administration of ANTX to the CNS as a therapeutic strategy for the treatment of neurological disorders [3][4][5]. Parkinson's disease (PD) is characterized by imbalanced cholinergic hyperactivity in the striatum of affected individuals [10,11].…”