Use of Botulinum Toxin A (BoNT-A) in Detrusor External Sphincter Dyssynergia (DESD): A Systematic Review and Meta-analysis

Goel, Shokhi; Pierce, Hudson; Pain, Kevin; Christos, Paul J.; Dmochowski, Roger R.; Chughtai, Bilal

doi:10.1016/j.urology.2020.03.007

Cited by 8 publications

(4 citation statements)

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“…Botulinum toxin can be effective in people with detrusor external urethral dyssyngergia. 15 In our study, as well as another publication, 6 parasympathomimetic and anti-inflammatory medications were also prescribed, although less frequently. Parasympathomimetics are often prescribed for suspected bladder atony, but clinical studies evaluating its efficacy are lacking.…”

Section: Final Outcome Scoressupporting

confidence: 50%

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Idiopathic functional urinary outflow tract obstruction in dogs, a retrospective case series (2010‐2021): 31 cases

Mathews,

Toedebusch,

Palm

et al. 2023

Veterinary Internal Medicne

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BackgroundIdiopathic functional urinary outflow tract obstruction (iFUOTO) is an uncommon but life‐limiting disease whose etiology and clinical course of disease remain poorly understood.ObjectiveCharacterize signalment, clinical signs, clinicopathologic findings, treatments, and propose a standardized response score for dogs with iFUOTO.AnimalsThirty‐one client‐owned dogs diagnosed with iFUOTO.MethodsRetrospective case series. Medical records from 2010 to 2021 were reviewed and findings recorded. Dogs were categorized based on the presence or absence of overt signs of neurological disease. Response to treatment was scored.ResultsThirty‐one dogs were included. All dogs had stranguria and 14 (45%) had overflow urinary incontinence. Mean age of onset for signs was 6.9 years±8 months. Twenty‐four dogs (77%) were castrated males, 5 (16%) intact males, and 2 (6%) spayed females. Eight (26%) of dogs had overt neurological deficits. Follow‐up data were available for 29 dogs (median 38 days, range: 2‐1277). Final outcome scores were not significantly different among dogs with overt signs of neurological disease (median score 2.5; range: 0‐3) and those without (median score 1; range; 0‐3; P = .35). Treatments included alpha antagonists, skeletal muscle relaxants, parasympathomimetics, anti‐inflammatories, castration, temporary placement of a urethral catheter, or a combination of these.Conclusions and Clinical RelevanceMultimodal treatment was frequently prescribed, but a standard outcome score is needed to evaluate the effectiveness of these therapies. Serial neurological examinations and monitoring of the dogs' dysuria are warranted.

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Section: Final Outcome Scoressupporting

confidence: 50%

“…The improvement in clinical signs for some dogs that were administered diazepam suggests abnormalities in both systems could be present. Botulinum toxin can be effective in people with detrusor external urethral dyssyngergia 15 …”

Section: Discussionmentioning

confidence: 99%

Idiopathic functional urinary outflow tract obstruction in dogs, a retrospective case series (2010‐2021): 31 cases

Mathews,

Toedebusch,

Palm

et al. 2023

Veterinary Internal Medicne

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“…A meta-analysis showed that Botox was effective in 60–78% of patients with DSD for reducing PVR and lowering detrusor pressure and detrusor leak-point pressure after treatment. To maintain the therapeutic effect, reinjection is required after 4–9 months, without significant adverse events [ 114 ].…”

Section: Clinical Applications Of Botox On Neurogenic and Non-neuroge...mentioning

confidence: 99%

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

Kuo

2022

Toxins

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Botulinum toxin A (Botox) had been considered a promising drug that has an effect on functional disorders of the lower urinary tract. Because Botox exhibits anti-inflammatory and antispasmodic effects, Botox injection into the bladder can decrease detrusor contractility, reduce bladder hypersensitivity, and eliminate painful sensations. Injecting Botox into the bladder outlet can relax the hyperactivity of the bladder neck, and of the urethral smooth and striated muscles. Based on these therapeutic effects, Botox has been widely applied to treat lower-urinary-tract dysfunctions (LUTDs) such as overactive bladder and neurogenic detrusor overactivity. However, this treatment has not been licensed for use in other LUTDs such as interstitial cystitis, voiding dysfunction due to benign prostatic hyperplasia in men, and dysfunctional voiding in women. Botox has also not been approved for the treatment of children with overactive bladder and dysfunctional voiding; in patients with spinal cord injuries with detrusor sphincter dyssynergia and autonomic dysreflexia; or for poorly relaxed external sphincter in non-neurogenic patients. This article reviews the current knowledge regarding Botox treatment for LUTDs and discusses the potential clinical applications of Botox, as well as work that can be conducted in the future.

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“…3,4 Transperineal injections of BoNT-A have been used for the treatment of BPH and DSD with moderate results. 5,6 While several studies have investigated the efficacy of BoNT-A injections for the treatment of BOO, the results have been mixed. There is still a literature gap regarding the role of transurethral botulinum injections for the management of BOO.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis

Gavi,

Ragonese,

Fettucciari

et al. 2024

Urologia

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Introduction: Botulinum toxin A (BoNT-A) injections in the prostate gland have been used as a minimally invasive option for treating bladder outlet obstruction (BOO). However, the efficacy of transurethral BoNT-A injections for BOO is not well established in the literature. The aim of this study is to collect evidence on the efficacy of transurethral BoNT-A injections for the treatment of BOO. Materials and methods: This systematic review and meta-analyses was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic literature search was performed till December 2022. The study population consisted of adult patients diagnosed with BOO, who underwent transurethral injections of BoNT-A for the treatment of BOO. Evidence synthesis: Out of 883 records, we identified seven studies enrolling 232 participants, of which only one nonrandomized controlled trial was found. Four prospective studies and two retrospective studies. Three studies included patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) and were included in the meta-analysis. Three studies included patients with urethral sphincter hyperactivity. One study included patients with primary bladder neck disease (PBND). All studies showed significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) at 3 and 6 months. The adverse events were mild in all studies. Hematuria, UTI, and urinary retention were reported across all studies. Conclusion: In conclusion, transurethral BoNT-A injections have been shown to improve LUTS, QoL, and urodynamic parameters of individuals with BOO at 3 and 6 months after injections, and no serious adverse effects have been reported. However, data on the long-term benefits of this treatment are scarce, and more prospective, randomized studies with larger samples examining various injection techniques, dosages, and extended follow-up of recurrent injections are needed.

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Use of Botulinum Toxin A (BoNT-A) in Detrusor External Sphincter Dyssynergia (DESD): A Systematic Review and Meta-analysis

Cited by 8 publications

References 44 publications

Idiopathic functional urinary outflow tract obstruction in dogs, a retrospective case series (2010‐2021): 31 cases

Idiopathic functional urinary outflow tract obstruction in dogs, a retrospective case series (2010‐2021): 31 cases

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

Efficacy of transurethral botulinum toxin A injections for bladder outlet obstruction: A systematic review and meta-analysis

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