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Botulinum toxin for detrusor overactivity and symptoms of overactive bladder: where we are now and where we are going

Nature Clinical Practice Urology volume 4, pages 379–386 (2007)Cite this article

Abstract

Botulinum toxin (BTX) treatment for overactive bladder and detrusor overactivity is becoming increasingly recognized as an excellent therapeutic option for treating patients refractory to anticholinergic agents. Results from open-label studies have suggested that this therapy is effective in neurogenic and idiopathic detrusor overactivity, yet validating evidence from randomized, placebo-controlled trials has been unavailable. The exact mechanism of action of BTX in the bladder is controversial, although evidence suggests that apart from preventing the presynaptic release of acetylcholine from the parasympathetic innervation to the bladder, it might have an effect on sensory mechanisms. The latter hypothesis could in part explain its effect on symptoms such as urgency. The purpose of this Review is to present the results of randomized, placebo-controlled trials in which BTX treatment for detrusor overactivity was investigated. Also the evidence supporting its potential dual mechanism of action in the bladder will be considered. In addition, the various techniques of administration of BTX are discussed and avenues for further research suggested.

Key Points

  • Botulinum toxin is becoming established as an excellent second-line therapeutic option in patients with refractory overactive bladder

  • Evidence from small, randomized, placebo-controlled trials indicates that botulinum toxin is an effective treatment for both neurogenic and idiopathic detrusor overactivity

  • Evidence suggests that botulinum toxin affects sensory neuronal pathways in the bladder, which leads to inhibition of the release of various neurotransmitters and downregulation in the expression of vanilloid and purinergic receptors

  • Currently, injection techniques of botulinum toxin vary worldwide but no conclusive data are available to support one method over another

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Figure 1: A schematic diagram of identifiable ultrastructural components of the human bladder wall

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Acknowledgements

The GKT Botulinum Study Group is composed of Mr Arun Sahai, Mr Mohammad Shamim Khan, Mr Prokar Dasgupta, Professor Kenneth Smith, Dr Norman Gregson, Dr Yue Sun, and Professor Richard Hughes.

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Authors and Affiliations

  1. and P Dasgupta is Consultant Urological Surgeon in the Departments of Urology and Clinical Neurosciences, A Sahai is a Specialist Registrar in Urology, MS Khan is a Consultant Urological Surgeon, N Gregson is an Honorary Senior Research Fellow in Neuroimmunology, K Smith is a Professor of Neurophysiology, Guy's Hospital and Guy's, King's and St Thomas' School of Medicine, London, UK.,

    Arun Sahai, Mohammad S Khan, Norman Gregson, Kenneth Smith & Prokar Dasgupta

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on behalf of the GKT Botulinum Study Group

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Correspondence to Prokar Dasgupta.

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Competing interests

A Sahai, MS Khan and P Dasgupta are currently investigators for Allergan, Inc., which manufactures and markets botulinum toxin-A (BOTOX®). N Gregson and K Smith declared they have no competing interests.

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Sahai, A., Khan, M., Gregson, N. et al. Botulinum toxin for detrusor overactivity and symptoms of overactive bladder: where we are now and where we are going. Nat Rev Urol 4, 379–386 (2007). https://doi.org/10.1038/ncpuro0839

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