Botulinum Toxin as a New Therapy Option for Voiding Disorders: Current State of the Art

Leippold, Thomas; Reitz, André; Schurch, Brigitte

doi:10.1016/s0302-2838(03)00250-1

Cited by 179 publications

(104 citation statements)

References 53 publications

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“…In the study with the longest follow-up, patients treated with BTX-A received an average of two treatments with a mean time of 7 months between two consecutive injections. 16 Although not observed in this trial or reported in other studies, repeated treatments could lead to an increase in drug tolerance, 21 drug resistance or antibody formation. 18 Administration of BTX is also more difficult than RTX and episodes of autonomic dysreflexia associated with the procedure may occur among SCI patients.…”

Section: Discussionmentioning

confidence: 59%

Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects

et al. 2007

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Study design: Systematic review. Objective: To evaluate effectiveness and adverse effects of botulinum toxin (BTX) for treatment of urinary incontinence (UI) due to detrusor overactivity (DO). Methods: Randomized controlled trials published in English before November 2006 were included if they enrolled subjects with UI caused by DO and reported incontinence outcomes. Results: Three trials totaling 104 subjects with DO refractory to antimuscarinic treatment were included. Two BTX-A trials enrolled primarily patients with NDO secondary to spinal cord injury (SCI) (93%). BTX-A decreased daily UI episodes compared to placebo but the reductions were only significantly different at a few of the time intervals during 24 weeks of follow-up. BTX-A was superior in reducing daily UI episodes in SCI subjects compared to intravesical resiniferatoxin at 12 and 18 months after injections. A small crossover study found BTX-B significantly more effective than placebo in reducing weekly UI episodes in subjects with predominately idiopathic DO. Adverse events (AEs) in BTX-A-treated subjects included urinary tract infection, pain at the injection site, hematuria and autonomic dysreflexia. Four subjects treated with BTX-B reported autonomic AEs. Conclusions: BTX may improve UI for subjects with refractory DO. The preferred dose and type of BTX is not known. Long-term efficacy and safety remain unclear and require conduct of larger RCT using standardized and validated clinical outcomes measures.

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Section: Discussionmentioning

confidence: 59%

Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects

et al. 2007

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“…Through paresis of striated sphincter urethral muscle and by reducing urethral resistance, patients with incomplete urination or urinary retention are able to resume spontaneous voiding with or without abdominal effort [1][2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Botulinum Toxin in voiding Dysfunction

Jp¹,

Godinho²,

Carlos³

et al. 2013

Med Surg Urol

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SummaryA 42-year-old patient was followed in urology clinic, complaining of recurrent LUTS (lower urinary tract symptoms) after being subjected to TUIP (transurethral incision of the prostate) at 38 years of age due to bladder neck hypertrophy.Urodynamic study was performed, and showed detrusor hypocontractility with an obstructive flow pattern and urethral hypertonicity.He was subjected to chemical sphincterotomy with botulinum toxin type-A (BTX-A), under cystoscopic control.After BTX-A, the patient reported improvement of the dynamic voiding pattern with frank improvement of the urodynamic parameters.

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“…The effectiveness and safety of this treatment has been assessed in a number of clinical trials. 12 The clinical effect of botulinum toxin results from a temporary chemical denervation in the target application area. 13 Axonal resprouting follows after several weeks or months, depending upon Alternative data suggest that the local action of intradetrusor botulinum toxin injection may effect a functional motor inhibition not associated with neuronal death.…”

Section: Discussionmentioning

confidence: 99%

Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study

et al. 2012

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Study design: This was a multicentre, prospective, randomised study. Objectives: To compare the outcomes of intradetrusor and suburothelial onabotulinumtoxinA injections in patients with spinal cord injury and refractory neurogenic detrusor overactivity (NDO). Setting: Urology departments of two tertiary hospitals in the Czech Republic. Methods: A total of 32 spinal cord injury patients with severe NDO refractory to the standard anticholinergic treatment were randomised to receive either intradetrusor or suburothelial 300 IU onabotulinumtoxinA injections. Subjective satisfaction, bladder diary data and urodynamic data were compared in both groups before treatment and at 3 months post treatment. Results: In all, 64.3% patients in the intradetrusor group and 88.8% patients in the suburothelial group were subjectively satisfied with the treatment. There was a significant post-treatment improvement in both groups regarding the number of catheterisations over 24 h, number of incontinence episodes over 24 h, catheterised volume, cystometric capacity, volume at first involuntary detrusor contraction, maximal detrusor pressure during filling and detrusor compliance. No significant differences between the groups were observed, with the exception of improvement of detrusor compliance, which was better in the intradetrusor group. There was one adverse effect comprising transient muscle weakness that was reported by one patient in the intradetrusor group. Conclusion: Results in both groups were comparable. The authors favour suburothelial onabotulinumtoxinA injection because this method allows more precise toxin localisation. Spinal Cord (2012) 50, 904-907; doi:10.1038/sc.2012.76; published online 17 July 2012Keywords: urodynamics; neurogenic detrusor overactivity; onabotulinumtoxinA; spinal cord injury; suburothelial injection INTRODUCTION Spinal cord injuries are among the most devastating of all injuries, often having life-changing and diverse consequences. Lower urinary tract dysfunction is commonly observed as a result of a spinal cord injury. Neurogenic detrusor overactivity (NDO) is frequently associated with upper motor neuron lesion, and the subsequent increased intravesical pressure may present a potential risk by causing damage to the upper urinary tract. 1 Current standard NDO treatment comprises individualised administration of anticholinergic medication; however, this therapy is inadequate for some patients and is often associated with unacceptable adverse effects. 2 Treatment with botulinum toxin offers an accepted alternative treatment for those patients in whom anticholinergic treatment has failed.Botulinum toxin is a neurotoxin produced by anaerobic microorganisms of the Clostridium genus. Botulinum toxin acts on the peripheral nervous system where it is responsible for blockade of acetylcholine release from presynaptic nerve endings. 3 This process results in blockade of the neuromuscular transfer, with a subsequent loss of muscle cell contractility.A further effect of botulinum toxin following administra...

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Botulinum Toxin as a New Therapy Option for Voiding Disorders: Current State of the Art

Cited by 179 publications

References 53 publications

Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects

Botulinum toxin for treatment of urinary incontinence due to detrusor overactivity: a systematic review of effectiveness and adverse effects

Botulinum Toxin in voiding Dysfunction

Intradetrusor versus suburothelial onabotulinumtoxinA injections for neurogenic detrusor overactivity: a pilot study

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