Botulinum Toxin—New Mechanisms, New Therapeutic Directions?

Chapple, Christopher R.; Patel, Anand

doi:10.1016/j.eururo.2006.01.005

Cited by 51 publications

(31 citation statements)

References 15 publications

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“…5, 7 Our study demonstrates that it does not induce vesicoureteral reflux during the 12-week follow-up after injection. In 2007, Karsenty et al 10 firstly reported that in the 11 female patients with nonneurogenic overactive bladder who received 100 U botox injection (five sites) into trigone, there was no induced VUR and the patient who had VUR at baseline showed no change in VUR grade at the 6-week videourodynamic test.…”

Section: Discussionmentioning

confidence: 55%

Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

et al. 2015

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Objectives:The objective of this study was to evaluate the effect and safety of trigonal injection of botulinum toxin A (BTX-A) for patients with neurological detrusor overactivity (NDO) with incontinence.Methods:A prospective, multicenter, single-blind and randomized controlled trial was conducted between June 2011 and June 2014. Spinal cord injury patients with urinary incontinence secondary to NDO overactivity were recruited. At a 1:1 ratio, patients randomly received 200 U BTX-A intradetrusor injections excluding the trigone (the control group) or 160 U intradetrusor and 40 U intratrigonal injections (the experimental group). Patients were evaluated at baseline and at 4 and 12 weeks after injection. The efficacy and safety outcomes included Incontinence-Specific-Quality-of-Life Instrument (I-QoL), voiding volume, urinary incontinence episodes, complete dryness, maximum detrusor pressure (Pdetmax) and volume at first involuntary detrusor contraction (VFIDC). Vesicoureteral reflux (VUR) and other adverse events were recorded.Results:Ninety-six patients were recruited and 91 of them completed the trial. Among the 91 patients, 47 were randomized to the experimental group and 44 to the control group. There were no significant differences in baseline evaluation items (gender, age, duration of spinal cord injury, level of neurological injury, AIS (the American Social Injury Association) scores) between the two groups. At 12 weeks, the improvement was significantly better in the experimental group compared with that in the control group for I-QoL (26.01 vs 18.75, P=0.01), mean urinary incontinence episodes (−5.22 vs −4.68 per day, P=0.01), complete dryness (13 vs 5, P=0.03), mean voiding volume (159.72 vs 139.07 ml, P=0.02), Pdetmax (−33.34 vs −28.02 cmH2O, P=0.04) and VFIDC (106.81 vs 97.86 ml, P=0.02), duration of first detrusor contraction (−41.54 vs −18.65 s, P=0.03) and the number of patients with detrusor contraction (−20 vs −9, P=0.02). In both the groups, no patients developed VUR.Conclusions:BTX-A intradetrusor and intratrigonal injections are more effective compared with those excluding the trigone for patients with NDO with incontinence. Intratrigonal injections do not induce VUR.

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Section: Discussionmentioning

confidence: 55%

Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

et al. 2015

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“…However, increasing evidence suggests that BTX may have a much greater range of neurological effects. BTX has been found to inhibit the release of a number of neurotransmitters, including acetylcholine and adenosine triphosphate, and neuropeptides such as substance P, as well as to downregulate the expression of purinergic and capsaicin receptors in afferent neurons within the bladder (Chapple and Patel, 2006). These data support the proposal that BTX works to treat DO and OAB by affecting both sensory and motor pathways.…”

Section: Methodsmentioning

confidence: 99%

Botulinum toxin in spinal cord injury patients with neurogenic detrusor overactivity

Cho

Kim

2016

J Exerc Rehabil

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Evidence for the efficacy and safety of intravesical onabotulinum toxin A (onabotA) injections has led to them being licensed in many countries, including Korea, for the treatment of patients with urinary incontinence due to neurogenic detrusor overactivity (NDO) resulting from spinal cord injury or multiple sclerosis who are refractory or intolerant to anticholinergic medications. OnabotA injections have an inhibitory effect on acetylcholine release for up to 10 months, with a recommended dose of 200 U. OnabotA treatment has a beneficial effect not only on urinary symptoms, but also on quality of life. Several clinical studies have shown onabotA to have better effects than placebo in achieving continence, reducing incontinence episodes, improving urodynamic parameters, and improving health-related quality of life. Urinary tract infections and postvoid residual volume are the most prevalent side effects. In patients with residual volume, clean intermittent catheterization may be necessary. In patients with spinal cord injury or multiple sclerosis, it is recommended to evaluate physical and cognitive function before intravesical onabotA injection to ensure that the patient and caregiver are able to perform catheterization if necessary. Further controlled trials should assess the optimal dose, injection technique, long-term safety of repeated injections, and optimal timing of onabotA treatment in the treatment of NDO.

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“…In MS patients, this therapy is recommended if NDO persists after antimuscarinic treatment or if antimuscarinic treatment is not tolerated due to side effects [4,5,20,21] (http://guidance.nice.org.uk/CG148). BoNT-A exerts its effects in the bladder, amongst others, by inhibiting the release of several neurotransmitters such as acetylcholine, resulting in striated muscle relaxation [27,28]. Studies with intravesical BoNT-A injections have shown clear clinical (e.g.…”

Section: Minimally Invasive Treatmentmentioning

confidence: 99%

Consensus guidelines on the neurologist's role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis

Ridder

Debruyne

et al. 2013

Clinical Neurology and Neurosurgery

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Botulinum Toxin—New Mechanisms, New Therapeutic Directions?

Cited by 51 publications

References 15 publications

Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

Combined detrusor-trigone BTX-A injections for urinary incontinence secondary to neurogenic detrusor overactivity

Botulinum toxin in spinal cord injury patients with neurogenic detrusor overactivity

Consensus guidelines on the neurologist's role in the management of neurogenic lower urinary tract dysfunction in multiple sclerosis

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