Key Points
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Intravesical injections of botulinum toxin subtype A (BoNT-A) are approved by the US FDA for the indications of neurogenic detrusor overactivity and idiopathic overactive bladder
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Results of phase III clinical trials have demonstrated that BoNT-A injections are superior to placebo; patients receiving BoNT-A have fewer lower urinary tract symptoms (LUTS) and a better quality of life
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Intravesical BoNT-A injections carry a risk of adverse events (such as increased post-void residual volume, acute urinary retention and UTI); thus, informed consent must be given before treatment
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The latest randomized control trials have failed to demonstrate any superiority of BoNT-A over placebo injections for the treatment of LUTS owing to BPH
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Clinical trials investigating BoNT-A for the treatment of interstitial cystitis/bladder pain syndrome have shown promising therapeutic effects in reducing bladder pain, repeat injections provide therapeutic effects of a longer duration
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Urethral BoNT-A injections decrease urethral resistance in patients with voiding dysfunction or detrusor–sphincter dyssynergia; effectiveness of BoNT-A injections in patients with non-neurogenic dysfunctional voiding or inadequate urethral relaxation is unclear
Abstract
Botulinum toxin subtype A (BoNT-A) is a potent neurotoxin that can selectively modulate neurotransmitter release from nerve endings, resulting in muscular paralysis. BoNT-A might also act on sensory nerves, and have an anti-inflammatory effect. In the first urological use of BoNT-A, injection into the urethral sphincters of patients with detrusor–sphincter dyssynergia resulted in a reduction of urethral resistance and improved voiding efficiency. Subsequently, intravesical BoNT-A injections have received regulatory approval for treatment of neurogenic detrusor overactivity owing to spinal cord lesions or multiple sclerosis, and idiopathic overactive bladder in adults. BoNT-A has also been widely used to treat patients with the off-label indications of neurogenic or non-neurogenic voiding dysfunction and male lower urinary tract symptoms owing to BPH and bladder-neck dysfunction. Other indications for which urologists have applied BoNT-A injections include interstitial cystitis/bladder pain syndrome, bladder oversensitivity and chronic pelvic pain syndrome. BoNT-A is currently delivered as an intravesical injection; however, use of liposome encapsulated formulations is also beginning to show some therapeutic potential.
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Change history
18 August 2015
In the version of this article initially published online registered trademark symbols were not included for all instances of uses of the proprietary product names Botox®, Dysport®, Xeomin® and Prosigne®. The error has been corrected for the print, HTML and PDF versions of the article.
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Jiang, YH., Liao, CH. & Kuo, HC. Current and potential urological applications of botulinum toxin A. Nat Rev Urol 12, 519–533 (2015). https://doi.org/10.1038/nrurol.2015.193
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DOI: https://doi.org/10.1038/nrurol.2015.193
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