OnabotulinumtoxinA injection therapy in men with LUTS due to primary bladder‐neck dysfunction: Objective and patient‐reported outcomes

Sacco, Emilio; Tienforti, Daniele; Bientinesi, Riccardo; D’Addessi, Alessandro; Racioppi, Marco; Pinto, Francesco; Totaro, Angelo; Vittori, Matteo; D’Agostino, Daniele; Bassi, Pierfrancesco

doi:10.1002/nau.22393

Cited by 14 publications

(28 citation statements)

References 26 publications

(54 reference statements)

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“…66 Injection of 100 units of BoNTA into the prostatic urethra and bladder neck provided significant improvements in symptom scores, Q max and PVR volume in patients with primary BND and videourodynamically proven obstruction. [67][68][69] These preliminary results suggest that BoNTA improves LUTD in men, probably by modulating the adrenergic sympathetic nerves or sensory pathways.…”

Section: Bph and Male Lutsmentioning

confidence: 73%

Current and potential urological applications of botulinum toxin A

Jiang

Liao

2015

Nat Rev Urol

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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.

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Section: Bph and Male Lutsmentioning

confidence: 73%

Current and potential urological applications of botulinum toxin A

Jiang

Liao

2015

Nat Rev Urol

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“…Poor bladder neck relaxation in BND may lead to weak stream and increased residual urine amount after voiding [63]. Recent studies demonstrated that BoNT-A injections in the external urethral sphincter, pelvic floor muscle, or bladder neck may offer promising therapeutic effects for DV symptoms improvement [61,64,65]. Synchronous significant reduction of the bladder outlet resistance and the pelvic floor pressure were observed in a study after BoNT-A injection treatment to the pelvic floor muscle, which indicates a more complex mechanism in DV symptoms.…”

Section: Bont-a Injection For Dysfunctional Voiding (Dv) or Bladder Nmentioning

confidence: 99%

“…IC/BPS is a clinical syndrome described as having "An unpleasant sensation (pain, pressure, discomfort) perceived to be related to urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable causes" [62]. Though the real pathophysiology of IC/BPS has remained unclear for decades, recent studies have progressed in molecular biology, which have focused on urothelial dysfunction and neurogenic inflammation and could explain some part of the disease [61][62][63][64][65][66]. Urothelial defect with surface glycosaminoglycan and associated dysregulation of urothelial permeability has been established as one of the pathogenesis of IC/BPS [65].…”

Section: Bont-a Injection For Ic/bpsmentioning

confidence: 99%

“…Though the real pathophysiology of IC/BPS has remained unclear for decades, recent studies have progressed in molecular biology, which have focused on urothelial dysfunction and neurogenic inflammation and could explain some part of the disease [61][62][63][64][65][66]. Urothelial defect with surface glycosaminoglycan and associated dysregulation of urothelial permeability has been established as one of the pathogenesis of IC/BPS [65]. IC/BPS also had upregulated P2X3 receptors and with increasing ATP release in the urothelium [66].…”

Section: Bont-a Injection For Ic/bpsmentioning

confidence: 99%

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Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders

Lin

Chiang

Cui

2020

Toxins

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Intravesical botulinum toxin (BoNT) injection is effective in reducing urgency and urinary incontinence. It temporarily inhibits the detrusor muscle contraction by blocking the release of acetylcholine (Ach) from the preganglionic and postganglionic nerves in the efferent nerves. BoNT-A also blocks ATP release from purinergic efferent nerves in the detrusor muscle. In afferent nerves, BoNT-A injection markedly reduces the urothelial ATP release and increases nitric oxide (NO) release from the urothelium. BoNT-A injection in the urethra or bladder has been developed in the past few decades as the treatment method for detrusor sphincter dyssyndergia, incontinence due to neurogenic or idiopathic detrusor overactivity, sensory disorders, including bladder hypersensitivity, overactive bladder, and interstitial cystitis/chronic pelvic pain syndrome. Although the FDA only approved BoNT-A injection treatment for neurogenic detrusor overactivity and for refractory overactive bladder, emerging clinical trials have demonstrated the benefits of BoNT-A treatment in functional urological disorders. Cautious selection of patients and urodynamic evaluation for confirmation of diagnosis are crucial to maximize the successful outcomes of BoNT-A treatment.

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“…There have been several theories regarding the etiology of PBNO, including muscular and neurologic dysfunction and fibrosis [5]. While medical treatment of the condition includes the use of α-blockers and the injection of agent such as onabotulinumtoxin A [6], the most common treatment is the surgical approach of transurethral incision [7] which is the treatment of choice for patients refractory to medical approaches. Despite a success rate of the surgical treatment for the disorder as high as 87% [7], the outcome remains unsatisfactory for a significant proportion of patients for whom pre-operative urodynamic studies failed to provide useful guidance for treatment.…”

Section: Introductionmentioning

confidence: 99%

Multiscale Entropy Analysis of Surface Electromyographic Signals from the Urethral Sphincter as a Prognostic Indicator for Surgical Candidates with Primary Bladder Neck Obstruction

Jiang

Liu

et al. 2015

Entropy

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Abstract:To explore information hidden in the electromyographic (EMG) signals of the urethral sphincter that may be of prognostic significance for patients with primary bladder neck obstruction (PBNO), 41 patients with voiding difficulty were divided into four groups: 1) patients with primary bladder neck obstruction (PBNO) with successful (Group 1, n = 14) and 2) unsuccessful (Group 2, n = 8) surgical outcomes, 3) patients with detrusor overactivity (Group 3, n = 7), and 4) patients with detrusor-external sphincter dyssynergia (Group 4, n = 12). All patients underwent baseline urodynamic studies (preoperative for Group 1 and Group 2) for comparison. The results demonstrated that, despite no significant difference in urodynamic parameters between Group 1 and Group 2, the large-scale multiscale entropy (MSE) of preoperative EMG (i.e., MSE LS (EMG)) of Group 1 was significantly higher than that of Group 2 without notable difference between Group 1 and Group 3 (i.e., patients with normal sphincter function). Moreover, the MSE LS (EMG) and small-scale MSE of preoperative EMG (i.e., MSE SS (EMG)) of Group 2 were notably higher than those of Group 4 (i.e., patients with abnormal sphincter function), while both MSE LS (EMG) and MSE SS (EMG) of Group 3 were notably higher than those of Group 2. In conclusion, using MSE analysis for assessing preoperative urethral sphincter EMG signals successfully distinguished between PBNO patients with subsequent successful surgery from those with surgical failure possibly due to subtle functional impairment of the urethral sphincter that cannot be detected by routine urodynamic studies. The results, therefore, highlight the potential clinical significance of this analytical tool in guiding urologists regarding their choice of medical versus surgical treatment for this patient population.

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OnabotulinumtoxinA injection therapy in men with LUTS due to primary bladder‐neck dysfunction: Objective and patient‐reported outcomes

Abstract: BoNT-A injection therapy appears effective and safe in medically refractory men with PBND, although repeated procedures are required for long-term sustained benefit. Randomized controlled trials are warranted in order to corroborate these results.

Cited by 14 publications

References 26 publications

Current and potential urological applications of botulinum toxin A

Current and potential urological applications of botulinum toxin A

Mechanism of Action of Botulinum Toxin A in Treatment of Functional Urological Disorders

Multiscale Entropy Analysis of Surface Electromyographic Signals from the Urethral Sphincter as a Prognostic Indicator for Surgical Candidates with Primary Bladder Neck Obstruction

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