OBJECTIVE To determine the effect of botulinum toxin type A (BTX‐A) on the release of the neuropeptides substance P (SP) and calcitonin gene‐related peptide (CGRP) from isolated bladder preparations after acute injury with HCl and the induction of cyclophosphamide (CYP)‐induced cystitis, as neurogenic inflammation has been increasingly identified in urological disorders such as interstitial cystitis. MATERIALS AND METHODS Adult rats had either an intraperitoneal injection with CYP or saline over a 10‐day period to induce chronic bladder inflammation, after which the bladder was harvested, or normal bladder explants were injured acutely with incubation (20 s) in HCl (0.4 m). To measure the effect of BTX‐A on the release of neurotransmitters, harvested bladders were incubated in an organ bath containing BTX‐A (10 U) or vehicle. Bladders were transferred to a subsequent bath (physiological saline) and incubated for 15 min, and the bathing medium analysed to measure neurotransmitter release, as determined by radioimmunoassay. Bladder specimens from sham treatment, controls and experimental rats were compared histologically. RESULTS Acute injury with HCl caused a significantly greater release of both CGRP and SP release (1235 and 1655 pg/g, respectively) than in controls (183 and 449 pg/g, respectively; P < 0.001). This increase in neurotransmitter release was partly inhibited by exposure to BTX‐A (870 and 1033 pg/g (P < 0.05 and <0.01). CYP‐induced chronic inflammation caused significantly greater release of SP than in the controls (1060 and 605 pg/g, respectively; P < 0.005). Exposure to BTX‐A partly inhibited the release of SP after CYP‐induced cystitis (709 pg/g, P < 0.05). CONCLUSIONS The application of BTX‐A inhibits the release of sensory neurotransmitters from isolated bladder preparations in rat bladder models of both acute injury and chronic inflammation, suggesting a potential clinical benefit of BTX‐A in the treatment of neurogenic inflammation.

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BTX-A application inhibits the evoked release of CGRP from afferent nerve terminals in isolated rat bladder. This finding suggests a potential clinical benefit of BTX-A for the treatment of interstitial cystitis or sensory urgency.

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Objective To assess the long-term outcome of patients intermittent catheterization after the explantation of eroded AUS cuÂs. In seven patients the AUS was who had an artificial urinary sphincter (AUS) implanted between 10 and 15 years ago. abandoned; two of these patients reverted to condom drainage and five had continent or incontinent urinary Patients and methods Of 68 patients who had an AUS implanted more than 10 years ago, 61 were followed diversions fashioned. Thus, if those who died with a functioning AUS are included, 46 of 61 (75%) with suÃcient detail for analysis. Thirty-four had a neuropathic bladder with sphincter dysfunction, 15 achieved long-term continence with the AUS. Conclusions Despite the high complication and revision had post-prostatectomy sphincter weakness incontinence and 12 further patients had a variety of rate, these results show that acceptable continence rates can be achieved in the long-term, particularly in indications.Results The 61 patients experienced a total of 58 major the male neuropathic bladder and in those with postprostatectomy sphincter weakness. Many of the comcomplications and 49 have required at least one revision procedure. Currently eight (13%) patients are plications encountered may be less common with the current re-designed models of the AUS. However, it is satisfactorily continent with their original AUS in situ and 29 others have a satisfactory revised AUS. Thus essential that both surgeon and patient recognize and accept the likelihood of complications and revisions 37 of 61 (61%) are continent using an AUS at least 10 years after first implantation. Eleven patients died before using the AUS. The continued use of the AUS where simpler methods of obtaining continence are and of these two had a satisfactory original AUS in situ and seven had successful revisions. In two patients inappropriate remains justified. Keywords Artificial urinary sphincter, urinary contithe AUS failed but they were considered unfit for revision. Four female patients were continent and used nence, complications, outcome details the outcome in patients who had an AUS