Abstract
Bladder oversensitivity arises from several different conditions involving the bladder, bladder outlet, systemic or central nervous system diseases. Increase of the bladder sensation results from activation of the sensory receptors in the urothelial cells or suburothelial tissues. Medical treatment targeting the overactive bladder (OAB) or interstitial cystitis (IC) might relieve oversensitive bladder symptoms (frequency, urgency and pain) in a portion of patients, but a certain percentage of patients still need active management. Botulinum toxin A (BoNT-A) has been demonstrated to have anti-inflammatory and antinociceptive effects in bladder sensory disorders and has been shown effective in the reduction of bladder oversensitivity and the increase of functional bladder capacity. For patients with OAB, urgency and urinary incontinence improved, while in patients with IC, bladder pain could be relieved in association with reduction of bladder oversensitivity after BoNT-A intravesical injection. Histological evidence has confirmed the therapeutic mechanism and clinical efficacy of intravesical BoNT-A injection on patients with OAB or IC. Bladder oversensitivity can also be relieved with the instillation of liposome encapsulated BoNT-A or low energy show waves (LESWs), which enable the BoNT-A molecule to penetrate into the urothelium and suburothelial space without affecting the detrusor contractility. Liposome encapsulated BoNT-A or combined LESWs and BoNT-A instillation might be future treatment alternatives for bladder oversensitivity in sensory bladder disorders.
Highlights
Bladder sensation arises from the urothelial cell and detrusor muscle stretching by signal transduction from peripheral receptors to the cerebral cortex
Bladder oversensitivity is usually existent with other lower urinary tract disorders (LUTD) such as bacterial cystitis, ketamine cystitis, interstitial cystitis (IC), bladder outlet obstruction (BOO), overactive bladder syndrome (OAB), idiopathic detrusor overactivity (DO), neurogenic DO (NDO); Toxins 2020, 12, 166; doi:10.3390/toxins12030166
All trials examining the use of botulinum toxin A (BoNT-A) injections into the urinary bladder for the treatment of OAB, DO, IC and bladder oversensitivity, and the studies reporting the treatment outcome such as urodynamic parameters, urinary incontinence improvement, and adverse events were included in this review
Summary
Bladder sensation arises from the urothelial cell and detrusor muscle stretching by signal transduction from peripheral receptors to the cerebral cortex. The factors which will increase bladder sensation include aging, the urinary bladder, bladder outlet conditions, or systemic diseases. This article reviews the pathophysiology, therapeutic mechanisms and treatment effects of BoNT-A on the improvement of the increased bladder sensation in bladder disorders, focused on OAB, DO, IC and bladder oversensitivity. This review study searched relevant articles identified by a literature search using MEDLINE/PubMed. Key words included OAB, bladder oversensitivity, DO, IC, bladder sensation, botulinum toxin A, BOTOX, and BTX-A. All trials examining the use of BoNT-A injections into the urinary bladder for the treatment of OAB, DO, IC and bladder oversensitivity, and the studies reporting the treatment outcome such as urodynamic parameters, urinary incontinence improvement, and adverse events were included in this review
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
