Onabotulinum Toxin A (Botox®) in the Treatment of Neurogenic Bladder Overactivity

Abstract

Botulinum toxin (BT) is a potent presynaptic neuromuscular blocking agent which induces selective, reversible muscle weakness for months when injected intramuscularly. During recent years BT has revolutionized the treatment of previously intractable symptoms of detrusor overactivity. Based on a systematic search of the PubMed database, a review of the current literature on the use of onabotulinum toxin A (Botox®) in the treatment of neurogenic detrusor overactivity is presented.Onabotulinum toxin A proved to be highly effective in the majority of studies, even though a wide range of injection techniques and dosages were described. The onset of the effect usually appeared before 2 weeks, and reached a peak within 2-6 weeks, with the clinical effect being maintained for approximately 6-8 months, or even longer. Depending on the dose, a number of patients developed high residual volume and clean intermittent self/helper catheterization (CIC) may become necessary. Only a few side effects were described, and intravesical onabotulinum toxin A injection seems to be well tolerated. However, details on injection technique, dose interval between injections, etc. are still under debate and only a few randomized, placebo controlled studies have been published.

Changes in chemical coding of sympathetic chain ganglia (SChG) neurons supplying porcine urinary bladder after botulinum toxin (BTX) treatment

“…For several years, BTX has also been used as an effective drug in experimental therapies of a range of neurogenic urinary bladder disorders and, since the end of 2011, it has been approved for the treatment of urinary incontinence secondary to neurogenic detrusor activity (Cruz et al 2011 ). The literature in the field contains many contributions regarding the possible clinical use of BTX in urology (see Rohrsted et al 2012 ; Pinto et al 2013 ; Santos-Silva et al 2013 ).…”

Long-Term Efficacy and Safety of Repeated Intravescial OnabotulinumtoxinA Injections Plus Hydrodistention in the Treatment of Interstitial Cystitis/Bladder Pain Syndrome

“…The risk of developing antibody-induced therapy failure appears to be low and depends on several variables, including patient-related factors, the dose administered, the immunologic quality of the preparation, and the interval between injections, etc . [ 26 ]. In this study, we examined the potential predictive factors for successful repeated intravesical BoNT-A injections in patients with refractory IC/BPS.…”

The use of urodynamic studies for the followup of neurogenic bladders treated with onabotulinumtoxinA

“…Furthermore, patients with neurologic disorder also may have asymptomatic high intravesical pressure or secondary hydronephrosis that can lead to damage the upper urinary tract. 1,2,5,6 The urologist plays a primordial role in providing patient care to achieve social continence, to minimize symptoms, and to protect renal function.…”

“…Intradetrusor injections of OnabotulinumtoxinA (BoNTA) has emerged as a safe and effective treatment for NDO. 1,2,3,4,5,6,8 Urodynamics (UDS) is currently used in the follow-up care of these patients that have benefited from the BoNTA treatment. In our local institutional follow-up protocol, UDS is performed at diagnosis, prior to BoNTA injection, 3 months after the first treatment and then 3 months after every 5th injection after the initial treatment.…”