Botulinum toxin in urology: a review of clinical potential in the treatment of urologic and sexual conditions

Abstract

BoNT-A has received regulatory approval for use in neurogenic DO and overactive bladder, but its use remains unlicensed in other lower urinary tract conditions such as non-neurogenic lower urinary tract symptoms in men with benign prostatic hyperplasia, bladder pain syndrome and DSD. Published literature shows that BoNT can be effective in carefully selected patient groups, has minimal adverse event profile and is generally well tolerated by many patients. However, many questions remain unanswered and larger scale multi-institutional studies are required to determine the key factors in BoNT treatment success.

Efectos de la toxina botulínica sobre la porción glandular de la próstata: fundamentos fisiopatológicos, mecanismo de acción y evidencias

“…(57) La TXB tiene un perfil de eventos adversos mínimos y, en general, es bien tolerado por muchos pacientes. (5) Hay pocos eventos adversos reportados en la literatura secundaria a la inyección de próstata con TXB. (52) En la serie de Arnouk et al, (41) se describe que las complicaciones fueron poco frecuentes y parecían estar relacionadas con la manipulación uretral en lugar de un resultado directo de la inyección de TXB: la hematuria macroscópica se observó en 5.8% de los pacientes, al igual que la retención urinaria transitoria y prostatitis aguda (5.8%).…”

“…(3) En los últimos años, se ha sugerido el papel de TXB-A como agente terapéutico para la hiperplasia prostática benigna (HPB) y otras disfunciones del tracto urinario inferior y sexuales como la hiperactividad de la vejiga/ detrusor hiperactiva, la disinergia del esfínter detrusor-esfínter (DSD), cistitis intersticial/ síndrome de vejiga dolorosa, dolor pélvico crónico y, más recientemente, la eyaculación precoz. (4,5) Su uso en la próstata fue descrito por primera vez por Doggweiler et al, (6) quienes estudiaron en 30 ratas el efecto de la TXB-A, hallando una atrofia generalizada de las células acinares de la próstata, así como una apoptosis glandular difusa. Este efecto se confirmó en 2 estudios posteriores en ratas y perros, respectivamente.…”

Toxins in Neurobiology: New tools from old molecules

“…The therapeutic potential of botulinum toxin, a large polypeptide inhibitor of neurotransmitter release at cholinergic nerve terminals, was recognised by German physician and poet Justinus Kerner as early as 1822 [16], and has been realised since with botulinum toxin finding application in the treatment of a range of human pathologies as well as extensive use for cosmetic purposes. These include, but are not limited to, treatment of hyperhidrosis, migraine, strabismus, overactive bladder and pelvic pain [17][18][19][20].…”

Current and emerging therapies in premature ejaculation: Where we are coming from, where we are going

“…It is used in dermatology for smoothing skin; it is used in gastrointestinal for decreasing the hypertonia of dysfunctional sphincters. In urology, it is approved for treatment of hyperactive bladder or detrusor over activity . Botulinum toxin has been proposed as a potential treatment for PE .…”

“…In urology, it is approved for treatment of hyperactive bladder or detrusor over activity. 91 Botulinum toxin has been proposed as a potential treatment for PE. 92 The mechanism would likely rely on the toxin's ability to paralyze the neural end-plate, decreasing the ability of the muscles associated with ejaculation to contract.…”