Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results

Simplified Bladder Botulinum-Toxin Delivery Technique Using Flexible Cystoscope and 10 Sites of Injection

Recently, the use of botulinum toxin A has been extended to patients with non-neurogenic urologic disorders such as refractory idiopathic overactive bladder. We describe a modification of our original injection technique that allows one to deliver botulinum toxin into the bladder quickly and efficiently in an office setting with reliable results and no local or systemic side effects.

Botulinum toxin injections for paediatric incontinence

PURPOSE OF REVIEW

This review highlights a recent innovation in the medical treatment of children with neurogenic detrusor overactivity. Anticholinergics are usually the main way to treat bladder overactivity. Side effects and lack of efficacy are the two main causes for considering alternative treatment. Up to recently, invasive surgery, mainly bladder augmentation, was the only available treatment for these intractable bladders. Here, we report on botulinum A toxin injection as an alternative to surgery in children with neurogenic detrusor overactivity.

RECENT FINDINGS

There are only four published articles on the use of botulinum A toxin in children with neurogenic detrusor overactivity. However, an increasing number of reports indicate clinical benefit and a good safety profile of botulinum A toxin in neurogenic and idiopathic detrusor overactivity. Extrapolation of the data published in adults treated with botulinum A toxin injections and understanding the mechanism of action on the detrusor muscle are worthwhile to encourage paediatric physicians to propose this option to their patients. Furthermore, the literature does not seem to warn against drug resistance or ultrastructural changes of the detrusor after repeated injection.

SUMMARY

Botulinum A toxin appears to be a reasonable alternative to surgery in the management of intractable overactive bladder in children. However, studies of the delivery method, site of injection, dose and long-term follow-up are required to confirm the good safety profile/clinical benefit of this new, minimally invasive approach.

Effects of benzalkonium chloride application on the rat bladder. A functional and histopathological study

AIM

To establish a new bladder denervation model for bladder augmentation, using benzalkonium chloride (BCl) treatment, and to characterize the normal and treated rat bladder both urodynamically and immunohistochemically.

METHODS

Adult Wistar rats were divided into two groups, and the bladders were treated with a local application of 0.3% BCl for 30 min in the denervation group and saline in the control group. Before and at the 8th week after treatment, cystometry was performed in all rats, and results were recorded. The bladders were removed and whole-mount sections were prepared, and also evaluated by immunohistochemistry.

RESULTS

BCl-treated rats showed a significant increase in bladder capacity (p < 0.05), but no significant change was observed in other cystometric parameters (p > 0.05) when compared with control rats. Immunohistochemistry revealed none or very few nerve fibers within the BCl-treated bladders.

CONCLUSIONS

The present study showed that denervation caused by BCl is useful for augmentation of the rat bladder. Bladder capacity was increased by the local application of BCl without impairing bladder functions. This method with a better understanding of the effects of BCl may be useful for augmentation in patients who have neurogenic bladder with low capacity.

Urologic applications of botulinum toxin therapy for voiding dysfunction

Botulinum toxin is primarily a presynaptic neuromuscular blocking agent inducing selective and reversible muscle weakness up to several months when injected intramuscularly in small quantities. The clinical use of botulinum toxin type-A has gained widespread acceptance and application for numerous adult and pediatric spasticity syndromes. This has led to the urologic adoption of this minimally invasive therapy for the treatment of idiopathic and neurogenic detrusor overactivity, interstitial cystitis, detrusor-sphincter dyssynergia, urinary retention, and prostatic conditions. Outlined below is an overview of the clinical adoption of this therapy for the treatment of various dysfunctions of the lower urinary tract.

A case for botulinum toxin-A in idiopathic bladder overactivity

Botulinum toxin (BTX) has been shown to be an effective agent in suppressing detrusor overactivity due to neurogenic causes. Similar to results obtained with traditional agents to treat bladder overactivity (ie, antimuscarinic medications), the use of BTX has been extended to patients with idiopathic detrusor overactivity. This article briefly reviews the use of BTX to treat disorders of detrusor overactivity and, based on early clinical and laboratory results, establishes the case for its use as a therapeutic modality to treat idiopathic detrusor overactivity.

From frown lines to fissures: Therapeutic uses for botulinum toxin

INTRODUCTION

Since the pharmacological mode of action of botulinum toxin (BTX) has been elucidated, its therapeutic potential has been increasingly recognised. The aims of this review were to summarize our current understanding of the pharmacological action of this agent and to review its therapeutic uses.

METHODS

An electronic literature search with Medline (January 1965 to December 2004) was carried out to identify articles related to the pharmacological mode of action and clinical uses for botulinum toxin using the keyword "botulinum toxin".

RESULTS AND CONCLUSION

Botulinum toxin A is emerging as a valuable clinical tool, both for diagnostic and therapeutic purposes in a wide variety of disorders, and is already the treatment of choice for selected conditions. Better understanding of its modes of action may identify alternative targets for pharmacological intervention, and may allow development of longer acting drugs with lower immunogenicity. Therapeutic uses of BTX-A must be assessed systematically in prospective studies, and the clinical role of other subtypes requires evaluation.

[Efficacy of botulinum toxin A for the treatment of detrusor hyperreflexia]

OBJECTIVE

To determinate the efficacy of botulinum toxin to treat refractory urinary incontinence due to bladder hyperreflexia.

METHOD

The international medical literature was reviewed from the Medline and Pubmed database.

DISCUSSION

The usual first line treatment of detrusor hyperreflexia is parasympathicolytic drugs and self cathterization. In case of lack of efficacy or severe side effects, a surgical procedure (enterocystoplasty) can be performed. 300 units of Botox injected into the detrusor permit a significant increase of bladder capacity and a significant decrease of maximal detrusor pressure for at last 6 months. But we did not find any double blind controlled studies in this indication and no fundamental studies focused on the mechanism of action of botulinum toxin on the bladder muscle. It is now impossible to conclude on the long term efficacy and toxicity.

CONCLUSION

Botulinum toxin injected into the detrusor muscle seems to be an efficient treatment of bladder hyperreflexia for 6 months in patients resistant to parasympathicolytic drugs. Long term efficacy and mechanism of action is actually not known.

[Botulinum toxin and spinal cord injury]

OBJECTIVE

To realize a clarification about the interest of the use of botulinum toxin in spinal cord injured patients.

METHOD

Interrogation of Medline database (crossing of botulinum toxin and spinal cord injury). We have also analyzed data from R. Poincaré Hospital in 2001.

RESULTS

Three articles of the twenty-five selected, treated effectively of botulinum toxin effect in the limbs muscles of spinal cord injured patients.

DISCUSSION

There are some indications of botulinum toxin in spinal cord injured patients ASIA C and D when spasticity induce focal functional discomfort. Indications are exceptional for ASIA A and B patients. No study showed improvement of functional abilities after botulinum toxin injection in spinal cord injured patients. Published studies only covered small number of patients.

Other noncosmetic uses of BOTOX

Botulinum toxin A has a wide variety of clinical applications, which are related by blockade of acetylcholine and often are related to abnormal muscle contractures. These applications include ocular disorders, disorders of the upper aerodigestive tract, dystonia and hemifacial spasm, cosmetic, gastrointestinal disorders, genitourinary disorders, management of pain, and use in autonomic nervous system disorders. Many of these diseases will be discussed with regard to their treatment with botulinum toxin compared to conventional treatments. Advantages and disadvantages of botulinum toxin use are delineated. General guidelines for adult and pediatric dosing will also be discussed.