Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra

Smith, Christopher P.; Nishiguchi, Jun; O’Leary, Margie; Yoshimura, Naoki; Chancellor, Michael B.

doi:10.1016/j.urology.2004.08.016

Cited by 176 publications

(127 citation statements)

References 8 publications

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“…If high doses of BTX-A are used, near-complete neuromuscular blockade of the detrusor results in impaired voiding and/or urinary retention. 4,[60][61][62][63] However, there is no compelling evidence at this time that BTX-A acts on the detrusor smooth muscle.…”

Section: Action On Striated Versus Smooth Musclementioning

confidence: 99%

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

et al. 2008

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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.

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Section: Action On Striated Versus Smooth Musclementioning

confidence: 99%

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

et al. 2008

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“…Toksin mesane taban› ve posterolateral duvarlarda 15-40 noktaya intramural olarak enjekte edilir. Mesane tavan›na intraperitoneal perforasyon ve barsak yaralanmas› riski nedeniyle, trigona vezikoüreteral reflü riski nedeniyle enjeksiyon yap›lmas› önerilmemektedir (14) . Nörojenik nedene ba¤l› olmayan detrüsör afl›r› aktivitesinde veya a¤r› J Turk Soc Obstet Gynecol 2013; 10: 9-15 veya duyu komponentlerinin bask›n oldu¤u hastalarda trigona da enjeksiyon önerilmifl ve iyi sonuçlar al›nm›flt›r (15).…”

Section: Botul‹nyum Toks‹n‹ Enjeks‹yonuunclassified

“…Bir çok çal›flmada hastalar BoNT enjeksiyonundan 4-6 hafta sonra de¤erlen-dirilmifllerdir. Bir çal›flmada maksimum etkinin enjeksiyondan 7-30 gün sonra görüldü¤ü belirtilmifltir (14) . BoNT uygulanan 35 hastayla yap›lan bir di¤er çal›flmada ifllemden sonra düzelmenin bafllamas› ortalama 5.3 gün (1-14) maksimum düzelme ise 8.3 gün (2-20) olarak belirtilmifltir (19) .…”

Section: Botul‹nyum Toks‹n‹ Enjeks‹yonuunclassified

Botulinum toxin and neuromodulation for overactive bladder treatment

Akman¹

2013

J Turk Soc Obstet Gynecol

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“…Im Gegensatz dazu zeigte auch hier die Studie von Flynn et al keine signifikante Veränderung [24]. Der MDP sank um durchschnittlich 5-50 cmH 2 O (20-60%) [4][5][6] Wochen nach der Injektion [12,[17][18][19][20]22,24,25,30]. In einer Studie von Kuo allerdings zeigte sich bei der suburothelialen Detrusorinjektion und der Injektion in den Blasenboden und Trigonum im Gegenteil ein geringfügiger, nicht signifikanter Anstieg des MDP um 10% [28] [23,27,30,32].…”

Section: Seite 8 Von 28unclassified

Botulinumtoxin bei nichtneurogenen Blasenfunktionsstörungen

Mehnert

Schurch

2009

Urologe

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Die nichtneurogene überaktive Harnblase mit oder ohne Detrusorüberaktivität und/oder Inkontinenz ist ein belastendes Symptom für viele Menschen, das bis vor wenigen Jahren nur mit anticholinergen Medikamenten oder operativ behandelt werden konnte. Intradetrusorinjektionen mit Botulinumtoxin Typ A stellen eine minimal-invasive Alternative für Patienten dar, die auf Anticholinergika nicht ansprechen oder diese nicht vertragen. Dieser Übersichtsartikel fasst die relevanten Arbeiten der letzten 6 Jahre zu diesem Thema zusammen und gibt Auskunft über die Wirksamkeit, die Nebenwirkungen, die verwendeten Dosierungen und Injektionstechniken. Insgesamt zeigte sich eine gute initiale Wirksamkeit, die etwa ab dem 4. Tag nach Injektion beginnt und durchschnittlich bis zu 31 Wochen anhalten kann. Es ist allerdings je nach Dosis mit einer Erhöhung der Restharnmengen zu rechnen, die auch die Anwendung von intermittierendem Selbstkatheterismus notwendig machen können. Die Anwendung von Botulinumtoxin in der Harnblase ist noch immer keine offiziell zugelassene Therapie. = Nonneurogenic overactive bladder with or without detrusor overactivity and/or incontinence is a bothersome symptom for many people. Until a few years ago, it could be treated only with anticholinergic drugs or invasive surgery. Intradetrusor injection with botulinum toxin type A is a minimally invasive alternative therapy option for patients who do not respond to or tolerate anticholinergic treatment. This literature overview summarises the relevant articles on this topic over the last 6 years and provides information on the efficacy, adverse events, currently used dosages, and injection techniques. Overall, a favourable initial efficacy has been observed starting around day 4 after injection and can last up to approximately 31 weeks. Depending on the dose, however, elevated postvoid residual volumes should be anticipated and might require clean intermittent self-catheterisation. The use of botulinum toxin in the urinary bladder is still considered off-label. Botulinum toxin in non-neurogenic bladder dysfunctionNon-neurogenic overactive bladder with or without detrusor overactivity and/or incontinence is a bothersome symptom for many people that could be treated only with anticholinergic drugs or invasiv surgery until a few years ago. Intradetrusor injection with botulinum toxin type-A is a minimally invasive alternative therapy option for patients, who do not respond to or tolerate anticholinergic treatment. This literature overview summarises the relevant articles on this topic of the last 6 years and provides information on the efficacy, adverse events, currently used dosages and injection techniques. Overall a favourable initial efficacy could be observed starting around day 4 after injection, which can last approximately up to 31 weeks. Depending on the dose however, elevated post void residual volumes have to be anticipated, which might even require clean intermittend self catheterisation. The use of botulinum toxin in the urinary bladder is stil...

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Single-institution experience in 110 patients with botulinum toxin A injection into bladder or urethra

Cited by 176 publications

References 8 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

Botulinum toxin and neuromodulation for overactive bladder treatment

Botulinumtoxin bei nichtneurogenen Blasenfunktionsstörungen

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