The Use of Botulinum Toxin A in Idiopathic Overactive Bladder Syndrome

Abstract

Overactive bladder syndrome continues to be a significant burden for the general population. Current first-line medical therapy often includes antimuscarinic medications designed for overactive bladder. Poor efficacy and significant side effects of these antimuscarinic medications have left patients and physicians looking for alternative treatments. There is increasing evidence that intradetrusor injection of botulinum toxin A can effectively treat these patients. We present a current and extensive review of the literature covering the use of botulinum toxin A in patients with overactive bladder with or without idiopathic detrusor overactivity.

Biomarkers in Overactive Bladder

“…The clinical impact of botulinum toxin is at the level of neurotransmitter releases at the presynaptic cholinergic nerve terminal, resulting in flaccid muscle paralysis; however, there is an expanding appreciation of the afferent signaling impact of botulinum toxin as well as modulation of several urothelial molecules, including NGF [32,33]. Recent compilations of studies on the use of botulinum toxin in patients with idiopathic OAB with or without concomitant DO revealed substantial efficacy despite wide ranges of dose, injection technique, follow-up, concomitant antimuscarinic utilization, and outcomes measures [34,35].…”

Future Directions in Overactive Bladder Treatment

“…A recent compilation of studies on the use of BTX-A in patients with idiopathic OAB with or without concomitant DO revealed substantial efficacy despite wide ranges in dose, injection technique, follow-up, concomitant antimuscarinic use, and outcomes measures [43,44]. Questions with regard to optimal dosing, timing, and avoidance of the clinically significant complication of urinary retention remain to be investigated in large-scale trials.…”

Neuromodulation for Overactive Bladder Symptoms in Women Utilizing Either Motor or Sensory/Motor Provocation With a Minimum Nine-Year Follow-Up

“…Medically recalcitrant bladder symptoms including frequency, urgency, and urgency incontinence afford patients few minimally invasive alternatives, although a number do exist including: sacral and pudendal neuromodulation (as of writing this is an off label utilization and not reimbursed by most insurance carriers), posterior tibial therapy and intravesical Botulinum Type A therapy (only approved for the redress of urgency incontinence in the United States) these can be utilized but only after the failure of conservative methods including biofeedback , bladder retraining and/or anticholinergic medication . Since the late 1990's, sacral neuromodulation may be the most well studied second tier treatment, and its success with frequency, urgency, and urgency incontinence has been consistently satisfactory.…”