Has botulinum toxin therapy come of age: what do we know, what do we need to know, and should we use it?

Abstract

Although still waiting for approval, BoNT/A detrusor injections can be safely offered to well informed patients with refractory neurogenic detrusor overactivity, as an alternative to more invasive therapies, such as bladder augmentation. Ongoing studies are expected to come up with the necessary information for definitive approval of BoNT/A in neurogenic detrusor overactivity patients. Regarding other possible applications such as idiopathic detrusor overactivity, benign prostatic enlargement and bladder pain syndrome/interstitial cystitis, its use should still be restricted to research centres in well designed clinical trials.

Neurological patients need evidence‐based urological care

“…There is however still much to be learned about the optimal use as number of injections, dose, dilution and site of injections. 62,63 There is also need to determine the cause of the complications as generalized muscle weakness observed in several cases. 64,65 Further research should focus on these issues.…”

Thoracic outlet syndrome secondary to localized scleroderma treated with botulinum toxin injection

“…However, studies show no evidence for the development of tissue fibrosis with repeat botulinum injections. For example, repeated botulinum injections in the detrusor muscle of patients with neurogenic detrusor overactivity and neurogenic bladder dysfunction did not increase the risk of bladder fibrosis (9, 10). Furthermore, it has been reported that the use of botulinum can improve urethral wound healing in rat urethral muscle by reducing tensile muscle forces that can lead to scarring (11).…”

Long-term outcomes of urinary tract reconstruction in patients with neurogenic urinary tract dysfunction

“…Botulinum neurotoxin A is the most clinically relevant subtype. [ 31 ] It acts as a reversible inhibitor of neurotransmitter (mainly acetylcholine) release at the neuromuscular junction of both striated and smooth muscle. Indications include DSD, idiopathic and neurogenic detrusor overactivity (NDO).…”