Abstract
OnabotulinumtoxinA (BoNT-A) was first used to treat neurogenic lower urinary tract dysfunction (LUTD) 30 years ago. Recently, application of BoNT-A in LUTD have become more common since the approval of intravesical BoNT-A injection for patients with both overactive bladders (OAB) and neurogenic detrusor overactivity (NDO) by regulatory agencies in many countries. Although unlicensed, BoNT-A has been recommended to treat patients with interstitial cystitis/bladder pain syndrome (IC/BPS) under different guidelines. BoNT-A delivery with liposome-encapsulation and gelation hydrogel intravesical instillation provided a potentially less invasive and more convenient form of application for patients with OAB or IC/BPS. BoNT-A injections into the urethral sphincter for spinal cord injury patients with detrusor-sphincter dyssynergia have been used for a long time. New evidence revealed that it could also be applied to patients with non-neurogenic dysfunctional voiding. Previous studies and meta-analyses suggest that BoNT-A injections for patients with benign prostate hyperplasia do not have a better therapeutic effect than placebo. However, new randomized and placebo-controlled trials revealed intraprostatic BoNT-A injection is superior to placebo in specific patients. A recent trial also showed intraprostatic BoNT-A injection could significantly reduce pain in patients with chronic prostatitis. Both careful selection of patients and prudent use of urodynamic evaluation results to confirm diagnoses are essential for successful outcomes of BoNT-A treatment for LUTD.
Highlights
Lower urinary tract dysfunction (LUTD) is a condition presented by patients suffering from LUTD linked to one or more structures and/or functions of the lower urinary tract [1]
Our results showed a significantly greater reduction in pain and increase in cystometric bladder capacity in the Botulinum toxin (BoNT)-A group compared with the normal saline injection group at eight weeks of follow-up
Our results revealed that patients who received BoNT-A injection had a significantly improved international prostate symptom score (IPSS), quality-of-life index, maximum flow rate, voided volume, and decreased detrusor voiding pressure at one month of follow-up
Summary
Lower urinary tract dysfunction (LUTD) is a condition presented by patients suffering from LUTD linked to one or more structures and/or functions of the lower urinary tract [1]. LUTD is common in both men and women, and the incidence and prevalence increase as people age [2]. A recent large cross-sectional study in China revealed 61.1% of women and 61.2% of men reported LUTD [2]. The pathophysiology of LUTD could be classified into bladder or bladder outlet dysfunction, and treatments of LUTD should focus on etiology. Not all LUTDs could be treated effectively, even if the etiology is definite. Treatment of functional LUTD, such as interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder (OAB), and dysfunctional voiding (DV), remains a challenge to the urologist
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