Management of Bladder, Prostatic and Pelvic Floor Disorders with Botulinum Neurotoxin (original) (raw)
Related papers
Use of botulinum toxin in urology: a literature review
European Journal of Therapeutics, 2018
Botulinum neurotoxin (BoNT) is currently preferred as a minimally invasive treatment for lower urinary tract pathologies. Although BoNT injections have become widespread globally for the past 5 years, today, the urological use of BoNT Type A (BoNT-A) is only licensed for the treatment of neurogenic detrusor overactivity and overactive bladder. Despite the relative evidence for the use of BoNT-A in benign prostatic enlargement, there is no high-level evidence data for the use in detrusor sphincter dyssynergia, interstitial cystitis/bladder pain syndrome, and chronic pelvic pain. In this comprehensive review, we mention the mechanism of action and efficacy of BoNT in various urological disorders, present the reliability, and evaluate the literature data supporting its use.
European urology, 2009
e u r o p e a n u r o l o g y 5 5 ( 2 0 0 9 ) 1 0 0 -1 2 0 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Context: The increasing body of evidence and number of potential indications for the use of botulinum neurotoxins (BoNTs) in the lower urinary tract (LUT) underlines the pressing need for evidence-based guidelines. Objective: A European expert panel consensus conference was convened with the main aim of evaluating the evidence and clinical considerations for the use of BoNTs in the treatment of urologic and pelvic-floor disorders and to propose relevant recommendations. Evidence acquisition: The quality of evidence from fully published English-language literature in the PubMed and EMBASE databases was assessed using the European Association of Urology (EAU) levels of evidence (LoE). Recommendations were graded and approved by a unanimous consensus of the panel. Evidence synthesis: The use of botulinum neurotoxin type A (BoNTA) is recommended in the treatment of intractable symptoms of neurogenic detrusor overactivity (NDO) or idiopathic detrusor overactivity (IDO) in adults (grade A). Caution is recommended in IDO because the risk of voiding difficulty and duration of effect have not yet been accurately evaluated. Repeated treatment can be recommended in NDO (grade B). The depth and location for bladder injections should be within the detrusor muscle outside the trigone (grade C). Dosage in children should be determined by body weight, with caution regarding total dose if also being used for treatment of spasticity, and minimum age (grade B). Existing evidence is inconclusive for recommendations in neurogenic detrusor-sphincter dyssynergia, bladder pain syndrome, prostate diseases, and pelvic-floor disorders. The use of BoNTA in the LUT with the current dosages and techniques is considered to be safe overall (grade A). Conclusions: The consensus committee recommends larger placebo-controlled and comparative trials to evaluate the efficacy of single and repeat injections, the duration of effect, the optimal dosage and injection technique, the timing for repeat injection, and the short-and long-term safety of the treatment in LUT and pelvic-floor disorders.
F1000 - Post-publication peer review of the biomedical literature
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.
The use of botulinum toxin for the treatment of urologic pain
Current Opinion in Urology, 2013
Purpose of review Botulinum toxin injections into the bladder have become established in the management of refractory detrusor overactivity and overactive bladder. Mechanism of action of the toxin appears to involve both efferent and afferent nerve pathways, as well as having an antinociceptive effect. Over the years, several reports of its use in refractory bladder pain syndrome and interstitial cystitis have emerged. We review the literature with a view to assessing efficacy and adverse events in this setting. Recent findings Small open-labelled studies have suggested botulinum neurotoxin serotype A (BoNT-A) to be an effective treatment for the majority of patients with refractory bladder pain syndrome/interstitial cystitis. A single set of injections result in demonstrable improvements in symptom scores and bladder pain, although some studies suggest repeated injections may be better. BoNT-A is more effective in nonulcer-type patients. In chronic pelvic pain syndrome, a recent placebo-controlled trial showed only a modest benefit for BoNT-A over placebo with a response rate of 30%.
Current Drug Delivery, 2010
Introduction and Aim: We report the 2-year efficacy and tolerability of intravesical botulinum A toxin (BoNT/A) injections in patients with painful bladder syndrome (PBS) associated with increased urinary frequency refractory to conventional treatments. Materials and Methods: Thirteen women were prospectively included in the study. The preliminary assessment included voiding diary, urodynamics, urinary tract ultrasound and the visual analog scale (VAS) for pain quantification. All patients received multiple injections of 200 U commercially available BoNT/A diluted in 20 ml 0.9% NaCl, under cystoscopic guidance. Clinical evaluation, urodynamics, urinary tract ultrasound and VAS were repeated at least two times per year throughout the follow-up. Results: A total of 58 injections were administered with a mean of 4.8 ± 0.8 injections per patient. The mean interval between two consecutive injections was 5.25 ± 0.75 months. At 1 and 4 mo follow up ten patients reported a subjective improvement. Mean VAS scores, mean daytime and night-time urinary frequency decreased significantly. Nine patients at 1 month and seven at the 4-month checkup complained of dysuria. The three non-responders to the first intravesical treatment session underwent another three months later with satisfactory results. At 1 and 2 years follow up the beneficial effects persisted in all patients. We did not observe any systemic side effects during the observation time. Conclusions: Intravesically injected BoNT/A is effective and safe in the medium-term management of patients with PBS. As the beneficial effect decreased progressively within a few months after treatment, repeat injections of the neurotoxin were needed over time.
European Urology, 2006
We evaluated the efficacy and tolerability of botulinum A toxin (BTX-A) intravesical injections in patients affected by painful bladder syndrome with increased urinary frequency, refractory to conventional treatment modalities.Twelve women and two men were prospectively included in the study. Under short general anaesthesia patients were given injections of 200 U of commercially available BTX-A diluted in 20 ml 0.9% NaCl. Injections were performed submucosally in the trigone and bladder floor under cystoscopic control. Voiding chart, the Visual Analog Scale (VAS) for pain, and urodynamics were performed before treatment and 1 and 3 mo afterward.Overall, 12 patients (85.7%) reported subjective improvement at 1 and 3 mo follow-up. The mean VAS score was significantly reduced at 1 and 3 mo after treatment (p < 0.05 for both); at the same time points daytime and nighttime urinary frequency significantly decreased (p < 0.01 and p < 0.05, respectively), and bladder cystometric capacity significantly increased (p < 0.01). Two patients reported incomplete bladder emptying. We did not detect any systemic side effects during or after treatment.The results of this pilot study indicate that BTX-A intravesical injections are effective in the short-term management of painful bladder syndrome. By modulating afferent C-fiber activity within the bladder walls, BTX-A significantly improves urodynamic parameters and reduces bladder pain and urinary frequency.