Recommendations on the Use of Botulinum Toxin in the Treatment of Lower Urinary Tract Disorders and Pelvic Floor Dysfunctions: A European Consensus Report

Apostolidis, Apostolos; Dasgupta, Prokar; Denys, Pierre; Elneil, Sohier; Fowler, Clare J.; Giannantoni, Antonella; Karsenty, G.; Schulte-Baukloh, Heinrich; Schurch, Brigitte; Wyndaele, Jean‐Jacques

doi:10.1016/j.eururo.2008.09.009

Cited by 278 publications

(185 citation statements)

References 133 publications

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“…Additionally, since BoNTA dose is cumulative, precautions should be taken when treating children with spasticity, as they may be receiving BoNTA at other sites in the same time period. The suggested age threshold for BoNTA use in children is three years old 55 and the recommended dosage is 5-10 units per kilogram of body weight. 55 For children with idiopathic OAB, 50-100 units are commonly used, 56 while up to 200-300 units can be used for those with neurogenic OAB.…”

Section: Intradetrusor Injections Of Botulinum Toxinmentioning

confidence: 99%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children's development. From the patient's perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures.Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.

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Section: Intradetrusor Injections Of Botulinum Toxinmentioning

confidence: 99%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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“…The toxin diluted in 10-30 mL of serum physiologic solution or 5% human albumin is injected to the base or walls of the bladder in 10-40 different regions ( Figure 1). [27,30] Injection to the dome of the bladder is not recommended to avoid perforation and intestinal infections. The data indicating that BTX type A affects the sensorial nerves has generated the idea of toxin injection to the trigone and suburethral region; no vesico-urethral reflux was observed after trigonal injections.…”

Section: Surgical Techniquementioning

confidence: 99%

“…[25,26] It was determined that in this way, the number of daily used pads decreases or complete dryness is ensured, and thus, the quality of life also increases. [27] The area of BTX type A use in urology could be summarized as detrusor overactivity, DSD, spastic conditions of the urethral rhabdosphincter, chronic prostatic pain, interstitial cystitis, non-fibrotic bladder outlet obstruction, and motor and sensorial urgency ( Table 1). Injections are contraindicated in cases of sensitivity to any of the substances in the toxin preparate and in the presence of infection.…”

Section: Mechanism Of Action and Indicationsmentioning

confidence: 99%

Botulinum toxin injections for treating neurogenic detrusor overactivity

Bayrak

Sadioglu

Onur

2015

Turkish Journal of Urology

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Neurogenic detrusor overactivity (NDO) is a disorder that can cause high intravesical pressure, decreased capacity, decreased bladder compliance, and upper urinary system damage. The current treatment options for NDO are established on the basis of agents that block parasympathetic innervation of the detrusor and inhibit involuntary bladder contractions. Several side effects, such as dryness of mouth, constipation, dyspepsia, changes in visual accommodation, somnolence, and being unable to obtain consistently favorable results, caused by anticholinergic agents, which are frequently used for this purpose, decrease the patient's compliance to treatment. Procedures such as neuromodulation, auto-augmentation, and enterocystoplasty are surgical options, and they could be used as the last alternative. Thus, botulinum toxin (BTX) injections to the detrusor have been commonly performed in recent years and lead to satisfactory results. The mechanism of action of BTX in NDO is based on the principal of smooth muscle relaxation in the bladder by the transient inhibition of neuromuscular nerve signals. The aim is to decrease acetylcholine secretion by blocking presynaptic vesicles in the neuromuscular junction. When studies were evaluated, it was observed that BTX injections to the detrusor muscle are a necessary and effective option in patients with incontinence caused by NDO. This treatment option could be indicated in situations where anticholinergic agents are not effective or could not be tolerated, and it could be a valuable alternative to major surgical treatments. In this review, we evaluated the effectiveness and reliability of BTX in patients with NDO.

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“…It can be ensured in a first attempt with a parasympatholytical treatment. Botulinum toxin A (BoNTA) is proposed in a second attempt in case of failure or intolerance of the parasympatholytics at an efficient dose (in mono or bi-therapy) in patients with intermittent catheterization or having accepted to do them [4,5]. It's following Brigitte Schurch's work that this new indication of BoNT developed [6].…”

Section: Introductionmentioning

confidence: 99%

Intra Detrusor Botulinum Toxin and Lower Limbs Motor Deficit: About 2 Clinical Cases

Khenioui¹,

Berre²

2016

J Clin Case Rep

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Objective: To demonstrate how a single intra detrusor botulinum toxin injection could be responsible for lower limbs proximal motor deficit.Results: Two women-37 and 38 years old-presenting with secondary progressive multiple sclerosis, having received intra detrusor botulinum toxin injections (400 BOTOX® U and 750 DYSPORT® U) due to major neurogenic detrusor over activity with high-pressure and risks of uro-nephrologic complications despite an efficient-dose anticholinergic bi-therapy (DITROPAN®/CERIS®). Few days in post-injection they present heavy tiredness, instability of the pelvis, and a major reduction of the walking distance. Those symptoms last for several months. During the emergency neurology consultation set up in the event of a new relapse, an aggravation of the paraparesis at the proximal level is observed. This deficit accounts for the realization of a corticosteroids bolus, the effectiveness of which is questioned by the patient. A cerebral and medullary MRI is performed in order to certify the appearance of new lesions. The MRI doesn't objectify any new lesions or any pathological contrast enhancement.Discussion: Ramirez-Castaneda et al. describe three means of dissemination of the BoNT: migration by systemic or neuronal transport, propagation/spread and diffusion. Conclusion:The retrograde migration of the botulinum toxin via hypo-gastric nerves seems to prevail. It could be followed by axonal anterograde transport causing a deficit on the hip flexors via the L2 nerve root.

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Recommendations on the Use of Botulinum Toxin in the Treatment of Lower Urinary Tract Disorders and Pelvic Floor Dysfunctions: A European Consensus Report

Cited by 278 publications

References 133 publications

Overactive bladder in children

Overactive bladder in children

Botulinum toxin injections for treating neurogenic detrusor overactivity

Intra Detrusor Botulinum Toxin and Lower Limbs Motor Deficit: About 2 Clinical Cases

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