Abstract
Botulinum neurotoxin (BoNT) is used to treat a variety of ailments, and its therapeutic application in lower urinary tract disorders (LUTDs) is well studied. Robust evidence supporting the efficacy and tolerability of BoNT in the treatment of neurogenic detrusor overactivity (NDO) and non-neurogenic overactive bladder (OAB) has led to regulatory approval for these conditions. Use of BoNT in the treatment of interstitial cystitis/bladder pain syndrome, chronic pelvic pain, and detrusor sphincter dyssynergia has demonstrated some promise, but is still evolving and off-label for these indications. Trials to date do not support the use of BoNT for benign prostatic hyperplasia. This comprehensive review outlines the mechanisms of BoNT in the treatment of LUTDs in adults and presents background and updated data examining the efficacy and adverse events associated with the use of BoNT in common urologic applications.
Highlights
Botulinum neurotoxin (BoNT) is formed by the Gram-positive, anaerobic spore forming bacteriaClostridium botulinum and is responsible for human botulism
Investigations into the multiple urologic applications of BoNT amplified. This comprehensive review will focus on the mechanism of action of BoNT, urologic administration, safety, and the data supporting its applications in lower urinary tract disorders (LUTDs) most relevant to practicing urologists
Kuo et al followed this study with a double-blind, placebo-controlled multicenter trial randomizing 60 patients to 20 ˆ 0.5 mL suburothelial injections to the posterior and lateral bladder wall of either 100 U onaBoNT-A or saline immediately followed by HD [67]
Summary
Botulinum neurotoxin (BoNT) is formed by the Gram-positive, anaerobic spore forming bacteria. Clostridium botulinum and is responsible for human botulism. Clinical applications of BoNT injections include chronic migraines, chronic pain, head and neck dystonias, strabismus, hyperhidrosis, anal fissures, and many others [1]. Use of BoNT in lower urinary tract disorders (LUTDs) was first studied by Dykstra et al in 1988 for the treatment of detrusor external sphincter dyssynergia (DSD) [2]. Investigations into the multiple urologic applications of BoNT amplified. This comprehensive review will focus on the mechanism of action of BoNT, urologic administration, safety, and the data supporting its applications in LUTDs most relevant to practicing urologists
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