Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-26T03:18:07.419Z Has data issue: false hasContentIssue false

Chapter 38 - Botulinum Neurotoxin Applications in Urological Disorders

Published online by Cambridge University Press:  02 November 2023

By
Brigitte Schurch  and
Stefano Carda
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
Get access

Summary

Botulinum neurotoxin (BoNT) is licensed for the treatment of a number of conditions characterized by striated muscle spasticity. However, in recent years, their unlicensed use in the treatment of lower urinary tract conditions has been described (Smith et al., 2004). Chief among these are conditions characterized by detrusor overactivity. Treatment of vulvodynia and chronic pelvic pain, benign prostate hyperplasia (BPH) and detrusor sphincter dyssynergia (DSD) are other emerging indications with promising positive results. This chapter details the use of BoNT for these conditions, giving a clinical definition of each condition, reviewing pertinent studies and describing the injection technique, percutaneous or endoscopic, using anatomical illustrations, and providing dosing recommendations.

Keywords

Botulinum neurotoxinBoNToveractive bladderdetrussor hyperreflexiavulvodyniapelvic painbladder painprostate painbenign prostatic hyperplasiadetrussor sphincter dyssynergiaautonomic dysreflexia
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 323 - 331
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abbott, JA, Jarvis, SK, Lyons, SD et al. (2006). Botulinum toxin type A for chronic pain and pelvic floor spasm in women: a randomized controlled trial. Obstet Gynecol, 108, 915–23. https://doi.org/10.1097/01.AOG.0000237100.29870.ccCrossRefGoogle ScholarPubMed
Abdel-Meguid, TA, Mosli, HA, Farsi, H et al. (2018). Treatment of refractory category III nonbacterial chronic prostatitis/chronic pelvic pain syndrome with intraprostatic injection of onabotulinumtoxinA: a prospective controlled study. Can J Urol, 25, 9273–80.Google ScholarPubMed
Bautrant, E, Porta, O, Murina, F et al. (2019). Provoked vulvar vestibulodynia: epidemiology in Europe, physio-pathology, consensus for first-line treatment and evaluation of second-line treatments. J Gynecol Obstet Hum Reprod, 48 , 685–8. https://doi.org/10.1016/j.jogoh.2019.04.011CrossRefGoogle ScholarPubMed
Bornstein, J, Goldstein, AT, Stockdale, CK et al. (2016). 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Sex Med, 13, 607–12.CrossRefGoogle ScholarPubMed
Bornstein, J, Preti, M, Simon, JA et al. (2019). Descriptors of vulvodynia: a multisocietal definition consensus (International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women Sexual Health, and the International Pelvic Pain Society). J Low Genit Tract Dis, 23, 161–3. https://doi.org/10.1097/LGT.0000000000000461CrossRefGoogle Scholar
Chapple, CR, Cruz, F, Cardozo, L et al. (2020). Safety and efficacy of mirabegron: analysis of a large integrated clinical trial database of patients with overactive bladder receiving mirabegron, antimuscarinics, or placebo. Eur Urol, 77(1), 119–28. https://doi.org/10.1016/j.eururo.2019.09.024CrossRefGoogle ScholarPubMed
Chen, S-L, Bih, L-I, Huang, Y-H et al. (2008). Effect of a single bodulinum toxin A injection to the external urethral sphincter for treating detrusor external sphincter dyssynergia in spinal cord injury. J Rehabil Med, 40, 744–8.CrossRefGoogle Scholar
Chen, S-L, Bih, L-I, Chen, G, Huang, Y-H, You, Y-H (2011). Comparing a transrectal ultrasound-guided with a cystoscopy-guided botulinum toxin a injection in treating detrusor external sphincter dyssynergia in spinal cord injury. Am J Phys Med Rehab, 90(9), 723–30. https://doi.org/10.1097/PHM.0b013e31821a72a3CrossRefGoogle ScholarPubMed
Crawford, ED, Hirst, K, Kusek, JW et al. ( 2011). Effects of 100 and 300 units of onabotulinum toxin A on lower urinary tract symptoms of benign prostatic hyperplasia: a phase II randomized clinical trial. J Urol, 186, 965–70.CrossRefGoogle ScholarPubMed
Cruz, F, Herschorn, S, Aliotta, P et al. (2011). Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol, 60(4), 742–50. https://doi.org/10.1016/j.eururo.2011.07.002CrossRefGoogle ScholarPubMed
De Rienzo, G, Minafra, P, Iliano, E et al.; Italian Society of Urodynamics (SIUD). (2022). Evaluation of the effect of 100U of Onabotulinum toxin A on detrusor contractility in women with idiopathic OAB: A multicentre prospective study. Neurourol Urodyn, 41(1), 306–12. https://doi.org/10.1002/Nau.24820Google ScholarPubMed
Diomande, I, Gabriel, N, Kashiwagi, M et al. (2019). Subcutaneous botulinum toxin type A injections for provoked vestibulodynia: a randomized placebo-controlled trial and exploratory subanalysis. Arch Gynecol Obstet, 299(4), 993–1000. https://doi.org/10.1007/s00404–019-05043-wCrossRefGoogle ScholarPubMed
Dowson, C, Watkins, J, Khan, MS, Dasgupta, P, Sahai, A (2012). Repeated botulinum toxin type A injections for refractory overactive bladder: medium-term outcomes, safety profile, and discontinuation rates. Eur Urol, 61(4), 834–9. https://doi.org/10.1016/j.eururo.2011.12.011CrossRefGoogle ScholarPubMed
Duthie, JB, Vincent, M, Herbison, GP, Wilson, DI, Wilson, D (2011). Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Reviews, 12, CD005493. https://doi.org/10.1002/14651858.CD005493.pub3Google Scholar
Fall, M, Baranowski, AP, Elneil, S et al.; European Association of Urology. (2010). EAU guidelines on chronic pelvic pain. Eur Urol, 57(1), 35–48. https://doi.org/10.1016/j.eururo.2009.08.020CrossRefGoogle ScholarPubMed
Gajewski, JB, Schurch, B, Hamid, R et al. (2018). An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neuroul Urodyn, 37(3), 1152–61. https://doi.org/10.1002/nau.23397Google ScholarPubMed
Gallien, P, Reymann, J-M, Amarenco, G et al. (2005). Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol, Neurosurg Psychiatry, 76(12), 1670–6. https://doi.org/10.1136/jnnp.2004.045765CrossRefGoogle ScholarPubMed
Ginsberg, D, Gousse, A, Keppenne, V et al. (2012). Phase 3 efficacy and tolerability study of onabotulinumtoxinA for urinary incontinence from neurogenic detrusor overactivity. J Urol, 187(6), 2131–9. https://doi.org/10.1016/j.juro.2012.01.125CrossRefGoogle ScholarPubMed
Gómez, I, Coronado, PJ, Martín, CM (2019). Study on the prevalence and factors associated to vulvodynia in Spain. Eur J Obstet Gynecol Reprod Biol, 240, 121–4.CrossRefGoogle Scholar
Haraldson, P, Mühlrad, H., Heddini, U, Nilsson, K, Bohm-Starke, N. (2020). Botulinum toxin A as a treatment for provoked vestibulodynia: a randomized controlled trial. ObstetGynecol, 1 36(3), 524–32. https://doi.org/10.1097/AOG.0000000000004008Google Scholar
Hedebo Hansen, T, Guldberg, R, Meinert, M. (2019). Botulinum toxin-treatment of localized provoked vulvodynia refractory to conventional treatment. Eur J Obstet Gynecol Reprod Biol, 234, 6–9. https://doi.org/10.1016/j.ejogrb.2018.12.013CrossRefGoogle ScholarPubMed
Herschorn, S, Gajewski, J, Ethans, K et al. (2011). Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. J Urol, 185(6), 2229–35. https://doi.org/10.1016/j.juro.2011.02.004CrossRefGoogle ScholarPubMed
Ikeda, Y, Zabbarova, IV, Birder, LA et al. (2012). Botulinum neurotoxin serotype A suppresses neurotransmitter release from afferent as well as efferent nerves in the urinary bladder. Eur Urol, 62(6), 1157–64. https://doi.org/10.1016/j.eururo.2012.03.031Google Scholar
Levesque, A, Ploteau, S, Michel, F et al. (2021). Botulinum toxin infiltrations versus local anaesthetic infiltrations in pelvic floor myofascial pain: multicentre, randomized, double-blind study. Ann Phys Rehab Med, 64(1), 101354. https://doi.org/10.1016/j.rehab.2019.12.009CrossRefGoogle ScholarPubMed
Manecksha, RP, Cullen, IM, Ahmad, S et al. (2012). Prospective randomised controlled trial comparing trigone-sparing versus trigone-including intradetrusor injection of abobotulinumtoxinA for refractory idiopathic detrusor overactivity. Eurn Urol, 61(5), 928935. https://doi.org/10.1016/j.eururo.2011.10.043Google ScholarPubMed
Marszalek, M, Wehrberger, C, Temml, C et al. (2009). Chronic pelvic pain and lower urinary tract symptoms in both sexes: analysis of 2749 participants of an urban health screening project. Eur Urol, 55(2), 499–508. https://doi.org/10.1016/j.eururo.2008.03.073CrossRefGoogle ScholarPubMed
Nitti, VW, Dmochowski, R. Herschorn, S et al.; EMBARK Study Group. (2013). OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol, 189(6), 2186–93. https://doi.org/10.1016/j.juro.2012.12.022Google ScholarPubMed
Parsons, BA, Goonewardene, S, Dabestani, S et al. (2022). The benefits and harms of botulinum toxin-A in the treatment of chronic pelvic pain syndromes: a systematic review by the European Association of Urology Chronic Pelvic Pain Panel. Eur Urol Focus, 8(1), 320–38. https://doi.org/10.1016/j.euf.2021.01.005Google ScholarPubMed
Robert, G, Descazeaud, A, Karsenty, G et al. (2018). Prostatic injection of botulinum toxin is not inferior to optimized medical therapy in the management of lower urinary tract symptoms due to benign prostatic hyperplasia: results of a randomized clinical trial. World J Urol, 36(6), 921–9. https://doi.org/10.1007/s00345–018-2193-yCrossRefGoogle Scholar
Smith, CP, Somogyi, GT, Boone, TB (2004). Botulinum toxin in urology: evaluation using an evidence-based medicine approach. Nat Clin Pract Urol, 1(1), 31–7. https://doi.org/10.1038/ncpuro0034CrossRefGoogle ScholarPubMed
Tubaro, A (2004). Defining overactive bladder: epidemiology and burden of disease. Urology, 64(6 Suppl 1), 2–6. https://doi.org/10.1016/j.urology.2004.10.047CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×