Histologic Features in the Urinary Bladder Wall Affected from Neurogenic Overactivity—A Comparison of Inflammation, Oedema and Fibrosis With and Without Injection of Botulinum Toxin Type A

Compérat, Éva; Reitz, André; Delcourt, A; Capron, Frédérique; Denys, Pierre; Chartier‐Kastler, Emmanuel

doi:10.1016/j.eururo.2006.01.025

Cited by 151 publications

(120 citation statements)

References 18 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…81 A single retrospective study has investigated the histopathological changes in excised human neurogenic overactive bladder tissue that might have been associated with intradetrusor BTX-A injection. 95 Full-thickness specimens from bladders previously treated with one or more injections of BTX-A showed significantly less fibrosis, but no differences in inflammation and edema compared with untreated bladders. There were no significant differences between specimens from responders and nonresponders to BTX-A with regard to inflammation, edema and fibrosis caused by BTX-A, although there was a trend towards reduced fibrosis and edema in responders.…”

Section: Histological Effects Of Btx-a Injectionmentioning

confidence: 90%

“…Treated bladders were injected with a mean of 1.5 ± 0.8 injections, and the mean time between the last injection and surgery was 6.8 ± 2.8 months. 95 The action of BTX-A seems to be reversible, long-lasting, and does not induce any enduring pathological changes; therefore, it has theoretical longevity in terms of its clinical usefulness in urological dysfunction. Regular BTX-A blockade of striated muscle activity over a 12-year period was shown to be clinically safe and effective in a study by Mejia and colleagues; 96 however, the long-term effects at a cellular level cannot be determined because biopsy was not performed.…”

Section: Histological Effects Of Btx-a Injectionmentioning

confidence: 99%

See 1 more Smart Citation

Drug Insight: biological effects of botulinum toxin A in the lower urinary tract

et al. 2008

View full text Add to dashboard Cite

SUMMARYBotulinum toxins can effectively and selectively disrupt and modulate neurotransmission in striated muscle. Recently, urologists have become interested in the use of these toxins in patients with detrusor overactivity and other urological disorders. In both striated and smooth muscle, botulinum toxin A (BTX-A) is internalized by presynaptic neurons after binding to an extracellular receptor (ganglioside and presumably synaptic vesicle protein 2C). In the neuronal cytosol, BTX-A disrupts fusion of the acetylcholine-containing vesicle with the neuronal wall by cleaving the SNAP-25 protein in the synaptic fusion complex. The net effect is selective paralysis of the low-grade contractions of the unstable detrusor, while still allowing high-grade contraction that initiates micturition. Additionally, BTX-A seems to have effects on afferent nerve activity by modulating the release of ATP in the urothelium, blocking the release of substance P, calcitonin gene-related peptide and glutamate from afferent nerves, and reducing levels of nerve growth factor. These effects on sensory feedback loops might not only help to explain the mechanism of BTX-A in relieving symptoms of overactive bladder, but also suggest a potential role for BTX-A in the relief of hyperalgesia associated with lower urinary tract disorders.

show abstract

Section: Histological Effects Of Btx-a Injectionmentioning

confidence: 90%

Section: Histological Effects Of Btx-a Injectionmentioning

confidence: 99%

Drug Insight: biological effects of botulinum toxin A in the lower urinary tract

et al. 2008

View full text Add to dashboard Cite

show abstract

“…There are repeatedly reports of treatment failures, even in those patients, who formerly showed an excellent treatment response to botulinumtoxin [16][17][18]. Not all treatment failures can be explained properly and one reason for this might be a variation in the amount of toxin that reaches its target area.…”

Section: Introductionmentioning

confidence: 99%

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

et al. 2009

Self Cite

View full text Add to dashboard Cite

OBJECTIVES: Although botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscarinic drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. Therefore, we investigated the distribution of the toxin solution after injection into the bladder wall, using magnet resonance imaging (MRI). METHODS: Six patients with NDO were recruited. Three of six patients received 300 U of BoNT/A + contrast agent distributed over 30 injection sites (group 1). The other three patients received 300 U of BoNT/A + contrast agent distributed over 10 injection sites (group 2). Immediately after injection, MRI of the pelvis was performed. The volume of the detrusor and the total volume of contrast medium inside and outside the bladder wall were calculated. RESULTS: In all patients, a small volume (mean 17.6%) was found at the lateral aspects of the bladder dome in the extraperitoneal fat tissue, whereas 82.4% of the injected volume reached the target area (detrusor). In both groups there was a similar distribution of the contrast medium in the target area. A mean of 33.3 and 25.3% of the total detrusor volume was covered in group 1 and 2, respectively. Six weeks after injection, five of six patients were continent and showed no detrusor overactivity in the urodynamic follow-up. No systemic side effects were observed. CONCLUSIONS: Our results provide morphological arguments that the currently used injection techniques are appropriate and safe.A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance Abstract ObjectivesAlthough botulinum neurotoxin type A (BoNT/A) intradetrusor injections are a recommended therapy for neurogenic detrusor overactivity (NDO), refractory to antimuscaric drugs, a standardisation of injection technique is missing. Furthermore, some basic questions are still unanswered, as where the toxin solution exactly spreads after injection. Therefore, we investigated the distribution of the toxin solution after injection into the bladder wall, using magnet resonance imaging (MRI). MethodsSix patients with NDO were recruited. 3 of 6 patients received 300 units of BoNT/A + contrast agent distributed over 30 injection sites (Group 1). The other 3 patients received 300 units of BoNT-A + contrast agent distributed over 10 injection sites (Group 2).Immediately after injection, MRI of the pelvis was performed. The volume of the detrusor and the total volume of contrast medium inside and outside the bladder wall were calculated. ResultsIn all patients, a small volume (mean 17.6%) was found at the lateral aspects of the bladder dome in the extraperitoneal fat tissue, whereas 82.4% of the injected volume reached the target area (detrusor).In both groups there was a similar distribution of the contrast medium in the target area.A mean of 33.3% and 25.3% of th...

show abstract

“…12,13 One possible explanation for the high failure rate of URS in the SCI population may be that chronic neurogenic bladder dysfunction can cause fibrosis and bladder wall contractures which alter the ureteral orifice and urethral anatomy. 14 In addition, patients with SCI often suffer from lower extremity contractures making positioning in the lithotomy position difficult or impossible. 15 In our current series, nearly half (45.5%) of failures were due to technical limitations (inability to access the ureteral orifice or inability to access stones), making this an important factor for patient counseling.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

et al. 2012

View full text Add to dashboard Cite

Study design: Retrospective study. Objectives: The purpose of this investigation was to review the outcomes and safety of retrograde ureteroscopic laser lithotripsy (URS) for the treatment of urolithiasis in the spinal cord injury (SCI) population. Setting: Virginia, USA. Methods: All patients with SCI who underwent URS with holmium:YAG laser lithotripsy for urolithiasis over a 15-year period were identified. Stone size, location and number at presentation were recorded. Information regarding patient characteristics, intra-operative complications, surgical efficacy, stone clearance, peri-operative complications, and follow-up stone events was collected and analyzed. Results: A total of 67 URS procedures were performed on 29 SCI patients during the study period with an average follow-up of 3.4 years. Patients had an average of 2.3 ipsilateral ureteroscopies. The majority (85.1%) used indwelling catheters for long-term bladder management, and complete stone clearance after the first procedure was 34.3%. Of the 44 cases with residual stones 44 mm, 20 (45.5%) were secondary to technical or procedural limitations. The intra-operative complication rate was comparable to non-SCI studies at 1.5%, but peri-operative complications were significantly higher at 29.9% with the majority due to urosepsis. Factors associated with peri-operative complications include chronic obstructive pulmonary disease, motor incomplete injuries and lack of a pre-operative ureteral stent. Conclusion: URS in the SCI population is an effective treatment for ureteral or renal stones but may be associated with greater risks and reduced efficacy. With advances in endourology, ureteroscopic surgery has become a popular choice for the minimally invasive treatment of urolithiasis. In the general population, studies reveal stone-free rates between 77 and 93% after one procedure. Success varies depending on size, number and location of stones. 2-5 Intra-operative complications range between 0 and 6%, and major peri-operative complications between 1 and 3%. 2,4,6 Unfortunately, it is not known whether these studies are directly applicable to patients with SCI. SCI results in neurogenic bladder, which significantly alters bladder function including ability to empty, bladder pressure, continence and bladder compliance. 7 Detrusor-sphincter-dyssynergia, a common problem in SCI patients with neurogenic bladder dysfunction, can cause elevated detrusor

show abstract

Histologic Features in the Urinary Bladder Wall Affected from Neurogenic Overactivity—A Comparison of Inflammation, Oedema and Fibrosis With and Without Injection of Botulinum Toxin Type A

Abstract: In our study injection of botulinum toxin into the detrusor muscle did not lead to increased fibrotic activity within the bladder wall, on the contrary patients with previous botulinum toxin injection revealed significant less fibrosis than patients without toxin injection.

Cited by 151 publications

References 18 publications

Drug Insight: biological effects of botulinum toxin A in the lower urinary tract

Drug Insight: biological effects of botulinum toxin A in the lower urinary tract

A morphological evaluation of botulinum neurotoxin A injections into the detrusor muscle using magnetic resonance imaging

Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population

Contact Info

Product

Resources

About