Botulinum toxin in the treatment of overactive bladder

Abstract

Clinical effectiveness of botulinum toxin (BTX) in the treatment of both neurogenic and idiopathic detrusor overactivity has been demonstrated in several studies. However, different protocols and techniques have been used by authors. METHODS. Literature review on intradetrusor injection of BTX for detrusor overactivity. RESULTS. The greatest clinical experience reports the use of 200 and 300 U Botox®. Available data suggest that clinical efficacy, duration, and the side effect profile is similar at these doses. Very few data, on the other hand, are available regarding the clinical outcomes using the Dysport® preparation; isolated reports support that efficacy is similar when using a dosing range of 500 to 1000 SU with increased risk of systemic side effects using 1000 SU. A variety of injection volumes was used, demonstrating similar efficacy and tolerability profile. Clinical effect duration extends six to ten months in the majority of studies. Data suggest that a repeated injection scheme proves successful in the vast majority of initial responders. CONCLUSIONS. Safety, effectiveness, specificity and reversibility make BTX a new attractive treatment modality for overactive bladder syndrome. However, more experience is needed to standardize the injection protocol with respect to therapeutic outcomes and adverse effects.

Overactive Bladder Syndrome: The Social and Economic Perspective

“…Una possibile alternativa nel trattamento della OAB severa è la stimolazione elettrica diretta delle radici del nervo sacrale (Sacral Neuromodulation -SNM) con uno stimolatore impiantabile. La SNM si è dimostrata essere efficace in più di 75% di pazienti con UUI severa (89). Das et al (90) hanno dimostrato che pazienti trattati con SMN riportavano un significativo miglioramento della loro HRQL con importante aumento nell'abilità percepita del soggetto di aumentare il proprio livello di performance nel lavoro e nelle altre attività quotidiane.…”

Social, economic, and health utility considerations in the treatment of overactive bladder

“…[91][92][93] Although these studies suggest an important role for intravesical BTX for OAB patients who fail other therapies, one has to be aware that this use remains off-label and based on limited clinical trials and little knowledge on the mechanism of action, long-term effects of chronic treatment, optimal dosing regimes, and sites of injection. 77,94 Electromotive drug administration (EMDA) combines iontophoresis and electrophoresis for targeted delivery of drugs to deep tissue layers by means of an electrical field created between electrodes. 95 It has been shown to be effective in patients diagnosed with OAB using lidocaine and dexamethasone as instilled drugs; however investigations of a larger group of patients are needed to provide sufficient evidence for the effectiveness of EMDA.…”

“… 91 – 93 Although these studies suggest an important role for intravesical BTX for OAB patients who fail other therapies, one has to be aware that this use remains off-label and based on limited clinical trials and little knowledge on the mechanism of action, long-term effects of chronic treatment, optimal dosing regimes, and sites of injection. 77 , 94 …”