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Use of botulinum toxin for treatment of non-neurogenic lower urinary tract conditions

Sangeeta T Mahajan, MD
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


Botulinum neurotoxin (BoNT) is a potent neurotoxin that is used for a variety of therapeutic indications (eg, dystonia, achalasia). Many clinicians are familiar with use of BoNT therapy for bladder and urethral dysfunction in patients with neurologic disorders (eg, spinal cord injury, multiple sclerosis). This agent is now gaining popularity for treatment of otherwise healthy patients with overactive bladder syndrome, benign prostatic hyperplasia, painful bladder syndrome/interstitial cystitis, and urinary retention following anti-incontinence surgery.

Use of BoNT for treatment of non-neurogenic lower urinary tract dysfunction is reviewed here. Treatment of neurogenic lower urinary tract dysfunction, other treatments for urgency incontinence and urinary retention, and the pharmacology of BoNT are discussed separately. (See "Chronic complications of spinal cord injury and disease" and "Symptom management of multiple sclerosis in adults" and "Management and prognosis of cerebral palsy" and "Treatment of urinary incontinence in women".)


A brief overview of the pharmacology of BoNT is presented here.

Mechanism — BoNT is produced by Clostridium botulinum, a gram-positive, anaerobic bacterium. BoNT acts by inhibiting calcium-mediated release of acetylcholine vesicles at the pre-synaptic neuromuscular junction in peripheral nerve endings [1]. This results in temporary flaccid muscle paralysis.

Formulations — Seven serologic forms of BoNT exist, including A, B, C, D, E, F, and G2, although only serotypes A and B are commercially available.


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Literature review current through: Sep 2016. | This topic last updated: Sep 8, 2016.
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