Use of botulinum toxin for treatment of non-neurogenic lower urinary tract conditions
- Sangeeta T Mahajan, MD
Sangeeta T Mahajan, MD
- Head, Division of Female Pelvic Medicine and Reconstructive Surgery
- Associate Professor of Obstetrics and Gynecology
- University Hospitals Case Medical Center
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 . 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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- Dosage and duration of action
- LOWER URINARY TRACT INDICATIONS
- Overactive bladder syndrome
- - Efficacy
- - Urinary retention rates
- - Comparison with other therapies
- - Clinical regimen
- - Follow-up
- Benign prostatic hyperplasia
- Interstitial cystitis/bladder pain syndrome
- Urinary retention after anti-incontinence surgery
- PROCEDURE FOR ADMINISTRATION
- Procedure video
- Informed consent
- Pretreatment catheterization training
- - Detrusor injection
- - Prostate injection
- - External urethral sphincter injection
- How to manage accidental overdose
- Development of resistance
- ADVERSE EFFECTS AND PRECAUTIONS
- Systemic absorption and FDA warning
- Maximum dose
- Urinary retention
- Urinary tract infection
- Other adverse effects
- SUMMARY AND RECOMMENDATIONS