Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Incontinence

Should we inject the trigone during botulinum toxin injection?

What is the optimum technique for delivering botulinum toxin to the bladder? Injection techniques vary worldwide and are unstandardized, and there is no consensus regarding whether technique actually matters. Most specialists believe that location and depth of injection is unlikely to alter efficacy, but studies have both confirmed and disputed these opinions.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Kuo, H. C. Comparison of effectiveness of detrusor, suburothelial and bladder base injections of botulinum toxin a for idiopathic detrusor overactivity. J. Urol. 178, 1359–1363 (2007).

    Article  PubMed  Google Scholar 

  2. Lucioni, A., Rapp, D. E., Gong, E. M., Fedunok, P. & Bales, G. T. Intravesical botulinum type A toxin injection in patients with overactive bladder: Trigone versus trigone-sparing injection. Can. J. Urol. 13, 3291–3295 (2006).

    PubMed  Google Scholar 

  3. Abdel-Meguid, T. A. Botulinum toxin-A injections into neurogenic overactive bladder—to include or exclude the trigone? A prospective, randomized, controlled trial. J. Urol. 184, 2423–2428 (2010).

    Article  CAS  PubMed  Google Scholar 

  4. Manecksha, R. P. et al. Prospective randomised controlled trial comparing trigone-sparing versus trigone-including intradetrusor injection of abobotulinumtoxinA for refractory idiopathic detrusor overactivity. Eur. Urol. doi: 10.1016/j.eururo.2011.10.043.

  5. Karsenty, G. et al. Botulinum toxin type a injections into the trigone to treat idiopathic overactive bladder do not induce vesicoureteral reflux. J. Urol. 177, 1011–1014 (2007).

    Article  PubMed  Google Scholar 

  6. Mascarenhas, F., Cocuzza, M., Gomes, C. M. & Leao, N. Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients. Neurourol. Urodyn. 27, 311–314 (2008).

    Article  CAS  PubMed  Google Scholar 

  7. Apostolidis, A., Dasgupta, P. & Fowler, C. J. Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur. Urol. 49, 644–650 (2006).

    Article  CAS  PubMed  Google Scholar 

  8. Kuo, H. C. Bladder base/trigone injection is safe and as effective as bladder body injection of OnabotulinumtoxinA for idiopathic detrusor overactivity refractory to antimuscarinics. Neurourol. Urodyn. 30, 1242–1248 (2011).

    PubMed  Google Scholar 

  9. Krhut, J. & Zvara, P. Intravesical instillation of botulinum toxin A: an in vivo murine study and pilot clinical trial. Int. Urol. Nephrol. 43, 337–343 (2011).

    Article  CAS  PubMed  Google Scholar 

  10. Chuang, Y. C. et al. Urodynamic and immunohistochemical evaluation of intravesical botulinum toxin A delivery using liposomes. J. Urol. 182, 786–792 (2009).

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

A. Sahai and P. Dasgupta acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Center award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. They also acknowledge the support of the MRC Center for Transplantation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arun Sahai.

Ethics declarations

Competing interests

A. Sahai and P. Dasgupta have received an unrestricted educational grant from and have been investigators for Allergan Ltd. A. Sahai has received honoraria for speaking on behalf of Allergan, Ltd. P. Dasgupta was a consultant for Allergan, Ltd.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sahai, A., Dasgupta, P. Should we inject the trigone during botulinum toxin injection?. Nat Rev Urol 9, 129–130 (2012). https://doi.org/10.1038/nrurol.2012.1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2012.1

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing