Abstract

Intravesical therapy with botulinum toxin type A (BTX-A) and vanilloids (capsaicin and resiniferatoxin) are actively investigated as potential treatments for lower urinary tract symptoms refractory to conventional therapy in patients with neurogenic detrusor overactivity. BTX-A cleaves soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins in afferent and efferent nerve endings, impeding the fusion of synaptic vesicles with the neuronal membrane necessary for the release of neurotransmitters. Vanilloids desensitize the transient receptor potential vanilloid type 1 receptor and inactivate C-fibers. BTX-A intradetrusor injections are extremely effective for treating urinary incontinence, provide adequate protection of the upper urinary tract, and improve quality of life in patients with neurogenic detrusor overactivity. Therefore, BTX-A is currently the mainstay of intravesical therapy. However, despite promising results overall, the administration of these compounds, including BTX-A, remains an experimental procedure requiring further clinical studies.

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