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-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T01:18:46.919Z Has data issue: false hasContentIssue false

18 - Botulinum toxin in urological disorders

Published online by Cambridge University Press:  28 July 2009

By
Brigitte Schurch  and
Dennis D. Dykstra
Edited by
Daniel Truong ,
Dirk Dressler  and
Mark Hallett
Daniel Truong
Affiliation:
Orange Coast Memorial Medical Center
Dirk Dressler
Affiliation:
Hannover Medical School, Hannover, Germany
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
Get access

Summary

Introduction

Botulinum toxins (BoNTs) are 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 amongst these are conditions characterized by detrusor overactivity. Treatment of vulvodynia and chronic pelvic pain, benign prostate hyperplasia, and detrusor sphincter dyssynergia are other emerging indications with promising positive results.

Overactive bladder

The International Continence Society (ICS) report of 2002 defined the overactive bladder syndrome as urgency, with or without urge incontinence, usually with frequency and nocturia, in the absence of local pathological or hormonal factors (Abrams et al.,2002). The prevalence in Europe and USA was estimated to be 3% among men 40–44 years of age, 9% among women 40–44 years of age, 42% among men 75 years of age or older, and 31% among women 75 years of age or older (Tubaro, 2004). The symptoms of overactive bladder have many potential causes and contributing factors. Urination involves the higher cortex of the brain, the pons, the spinal cord, the peripheral autonomic, somatic, and sensory afferent innervation of the lower urinary tract, and the anatomical components of the lower urinary tract itself. Disorders of any of these structures may contribute to the symptoms of overactive bladder (Figure 18.1).

A variety of efferent and afferent neural pathways, reflexes, and central and peripheral neurotransmitters are involved in urine storage and bladder emptying.

Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 153 - 160
Publisher: Cambridge University Press
Print publication year: 2009

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

Abrams, P., Cardozo, L., Fall, M., et al. (2002). The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn, 21(2), 167–78.CrossRefGoogle ScholarPubMed
Apostolidis, A., Dasgupta, P. & Fowler, C. J. (2006). Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol, 49(4), 644–50.CrossRefGoogle ScholarPubMed
Bachmann, G. A., Rosen, R., Pinn, V. W., et al. (2006). Vulvodynia: a state-of-the-art consensus on definitions, diagnosis and management. J Reprod Med, 51(6), 447–56.Google ScholarPubMed
Brin, M. F. & Vapnek, J. M. (1997). Treatment of vaginismus with botulinum toxin injections. Lancet, 349(9047), 252–3.CrossRefGoogle ScholarPubMed
Chuang, Y. C., Chiang, P. H., Huang, C. C., Yoshimura, N. & Chancellor, M. B. (2005). Botulinum toxin type A improves benign prostatic hyperplasia symptoms in patients with small prostates. Urology, 66(4), 775–9.CrossRefGoogle ScholarPubMed
Seze, M., Petit, H., Gallien, P., et al. (2002). Botulinum a toxin and detrusor sphincter dyssynergia: a double-blind lidocaine-controlled study in 13 patients with spinal cord disease. Eur Urol, 42(1), 56–62.CrossRefGoogle ScholarPubMed
Doggweiler, R., Zermann, D. H., Ishigooka, M. & Schmidt, R. A. (1998). Botox-induced prostatic involution. Prostate, 37(1), 44–50.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Dykstra, D., Enriquez, A. & Valley, M. (2003). Treatment of overactive bladder with botulinum toxin type B: a pilot study. Int Urogynecol J Pelvic Floor Dysfunct, 14(6), 424–6.CrossRefGoogle ScholarPubMed
Dykstra, D. D. & Presthus, J. (2006). Botulinum toxin type A for the treatment of provoked vestibulodynia: an open-label, pilot study. J Reprod Med, 51(6), 467–70.Google Scholar
Dykstra, D. D. & Sidi, A. A. (1990). Treatment of detrusor-sphincter dyssynergia with botulinum A toxin: a double-blind study. Arch Phys Med Rehabil, 71(1), 24–6.Google ScholarPubMed
Dykstra, D. D., Sidi, A. A., Scott, A. B., Pagel, J. M. & Goldish, G. D. (1988). Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol, 139(5), 919–22.CrossRefGoogle ScholarPubMed
Gallien, P., Robineau, S., Verin, M., et al. (1998). Treatment of detrusor sphincter dyssynergia by transperineal injection of botulinum toxin. Arch Phys Med Rehabil, 79(6), 715–17.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
Ghazizadeh, S. & Nikzad, M. (2004). Botulinum toxin in the treatment of refractory vaginismus. Obstet Gynecol, 104(5 Pt 1), 922–5.CrossRefGoogle ScholarPubMed
Ghei, M., Maraj, B. H., Miller, R., et al. (2005). Effects of botulinum toxin B on refractory detrusor overactivity: a randomized, double-blind, placebo controlled, crossover trial. J Urol, 174(5), 1873–7; discussion 1877.CrossRefGoogle ScholarPubMed
Giannantoni, A., Di Stasi, S. M., Stephen, R. L., et al. (2004). Intravesical resiniferatoxin versus botulinum-A toxin injections for neurogenic detrusor overactivity: a prospective randomized study. J Urol, 172(1), 240–3.CrossRefGoogle ScholarPubMed
Gunter, J. & Brewer, A. (2002). Botulinum toxin A for generalized vulvar dysaesthesia. J Pain, 21(April 3 (2Suppl 1)), Abstract 681.Google Scholar
Gunter, J., Brewer, A. & Tawfik, O. (2004). Botulinum toxin a for vulvodynia: a case report. J Pain, 5(4), 238–40.CrossRefGoogle ScholarPubMed
Gunter, J., Quan, D., Martel, R. & Teal, S. (2005). A prospective study of botulinum toxin for vestibulodynia. Toxin Meetings Denver Co June 23.25, 2005. Abstract 39A.
Howard, F. M. (2003). Chronic pelvic pain. Obstet Gynecol, 101(3), 594–611.Google ScholarPubMed
Jarvis, S. K., Abbott, J. A., Lenart, M. B., Steensma, A. & Vancaillie, T. G. (2004). Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles. Aust N Z J Obstet Gynaecol, 44(1), 46–50.CrossRefGoogle ScholarPubMed
Karsenty, G., Reitz, A., Lindemann, G., Boy, S. & Schurch, B. (2006). Persistence of therapeutic effect after repeated injections of botulinum toxin type A to treat incontinence due to neurogenic detrusor overactivity. Urology, 68(6), 1193–7.CrossRefGoogle ScholarPubMed
Kessler, T. M., Danuser, H., Schumacher, M., et al. (2005). Botulinum A toxin injections into the detrusor: an effective treatment in idiopathic and neurogenic detrusor overactivity?Neurourol Urodyn, 24(3), 231–6.CrossRefGoogle ScholarPubMed
Kuo, H. C. (2005). Prostate botulinum A toxin injection–an alternative treatment for benign prostatic obstruction in poor surgical candidates. Urology, 65(4), 670–4.CrossRefGoogle ScholarPubMed
Mall, V., Glocker, F. X., Frankenschmidt, A., et al. (2001). Treatment of neuropathic bladder using botulinum toxin A in a 1-year-old child with myelomeningocele. Pediatr Nephrol, 16(12), 1161–2.CrossRefGoogle Scholar
Maria, G., Brisinda, G., Civello, I. M., et al. (2003). Relief by botulinum toxin of voiding dysfunction due to benign prostatic hyperplasia: results of a randomized, placebo-controlled study. Urology, 62(2), 259–64; discussion 264–5.CrossRefGoogle ScholarPubMed
Meredeth, M., Karp, B., Bartrum, D., Zimmer, C. & Stratton, P. (2006). Botulinum toxin in the treatment of chronic pain and endometriosis. J Soc for Gynecol Investig, 13(2(Suppl)), 276A.Google Scholar
Park, D. S., Lee, Y. K., Jeong, H. S., et al. (2005). The initial experience of intraprostatic injection of botulinum toxin type A for benign prostatic hyperplasia: a comparative study of short-term effect with transurethral resection of prostate. Koran J Urol, 46(11), 1173–9.Google Scholar
Petit, H., Wiart, L., Gaujard, E., et al. (1998). Botulinum A toxin treatment for detrusor-sphincter dyssynergia in spinal cord disease. Spinal Cord, 36(2), 91–4.CrossRefGoogle ScholarPubMed
Phelan, M. W., Franks, M., Somogyi, G. T., et al. (2001). Botulinum toxin urethral sphincter injection to restore bladder emptying in men and women with voiding dysfunction. J Urol, 165(4), 1107–10.CrossRefGoogle ScholarPubMed
Popat, R., Apostolidis, A., Kalsi, V., et al. (2005). A comparison between the response of patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity to the first intradetrusor injection of botulinum-A toxin. J Urol, 174(3), 984–9.CrossRefGoogle ScholarPubMed
Sahai, A. (2007). Efficacy of botulinum toxin-A for treating idiopathic detrusor overactivity: results from a single center, randomized, double-blind placebo controlled trial. J Urol, 177(6), 2231–6.CrossRefGoogle Scholar
Schmid, D. M., Sauermann, P., Werner, M., et al. (2006). Experience with 100 cases treated with botulinum-A toxin injections in the detrusor muscle for idiopathic overactive bladder syndrome refractory to anticholinergics. J Urol, 176(1), 177–85.CrossRefGoogle ScholarPubMed
Schurch, B., Hauri, D., Rodic, B., et al. (1996). Botulinum-A toxin as a treatment of detrusor-sphincter dyssynergia: a prospective study in 24 spinal cord injury patients. J Urol, 155(3), 1023–9.CrossRefGoogle ScholarPubMed
Schurch, B., Hodler, J. & Rodic, B. (1997). Botulinum A toxin as a treatment of detrusor-sphincter dyssynergia in patients with spinal cord injury: MRI controlled transperineal injections. J Neurol Neurosurg Psychiatry, 63(4), 474–6.CrossRefGoogle ScholarPubMed
Schurch, B., Schmid, D. M. & Knapp, P. A. (1999). An update on the treatment of detrusor-sphincter dyssynergia with botulinum toxin type A. Eur J Neurol, 6(Suppl 4), S83–9.CrossRefGoogle Scholar
Schurch, B., Stöhrer, M., Kramer, G., et al. (2000). Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol, 164(3 Pt 1), 692–7.CrossRefGoogle ScholarPubMed
Schurch, B., Sèze, M., Denys, P., et al. (2005). Botulinum toxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol, 174(1), 196–200.CrossRefGoogle ScholarPubMed
Shafik, A. & El-Sibai, O. (2000). Vaginismus: results of treatment with botulinum toxin. J Obstet Gynaecol, 20(3), 300–2.Google Scholar
Smith, C. P., Somogyi, G. T. & Boone, T. B. (2004). Botulinum toxin in urology: evaluation using an evidence-based medicine approach. Nat Clin Pract Urol, 1(1), 31–7.CrossRefGoogle ScholarPubMed
Thompson, A. J., Jarvis, S. K., Lenart, M., Abbott, J. A. & Vancaillie, T. G. (2005). The use of botulinum toxin type A (Botox) as treatment for intractable chronic pain associated with spasms of the levator ani muscles. BJOG, 112(2), 247–9.CrossRefGoogle Scholar
Tubaro, A. (2004). Defining overactive bladder: epidemiology and burden of disease. Urology, 64(6 Suppl 1), 2–6.CrossRefGoogle ScholarPubMed
Wheeler, J. S.., Walter, J. S., Chintam, R. S. & Rao, S. (1998). Botulinum toxin injections for voiding dysfunction following SCI. J Spinal Cord Med, 21(3), 227–9.CrossRefGoogle ScholarPubMed
Zermann, D., Ishigooka, M., Schubert, J. & Schmidt, R. A. (2000). Perisphincteric injection of botulinum toxin type A. A treatment option for patients with chronic prostatic pain? Eur Urol, 38(4), 393–9.CrossRefGoogle ScholarPubMed
Zermann, D. H., Ishigooka, M., Doggweiler-Wiygul, R., Schubert, J. & Schmidt, R. A. (2001). The male chronic pelvic pain syndrome. World J Urol, 19(3), 173–9.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org 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
×