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Sphincteric Injection of Botulinum Toxin for Urinary Retention due to Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Nano-BTA: A New Strategy for Intravesical Delivery of Botulinum Toxin A. Int Neurourol J 2022; 26:92-101. [PMID: 35793987 PMCID: PMC9260331 DOI: 10.5213/inj.2142124.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 01/22/2023] Open
Abstract
Botulinum neurotoxin subtype A (BoNT-A) has been part of the urology treatment arsenal since it was first used in the treatment of detrusor-sphincter dyssynergia more than 30 years ago. BoNT-A has been recommended as an effective treatment for neurogenic detrusor overactivity and overactive bladder. However, direct intradetrusor injection of BoNT-A using cystoscopy after anesthesia may cause hematuria, pain, and infection; these adverse events have motivated urologists to find less invasive and more convenient ways to administer BoNT-A. The development of nanotechnology has led to the advancement of intravesical drug delivery. Using versatile nanocarriers to transport BoNT-A across the impermeable urothelium is a promising therapeutic option. In this review, we discuss the effectiveness and feasibility of liposomes, thermosensitive polymeric hydrogels, and hyaluronan-phosphatidylethanolamine as carriers of BoNT-A for intravesical instillation. To date, these carriers have not reached a similar efficacy as intradetrusor injections in long-term observations. Hopefully, researchers will make a breakthrough with new nanomaterials to develop clinical applications in the future.
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Systemic muscular weakness after botulinum toxin A administration: a review of the literature. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Goodrich C, York H, Shapiro A, Gorman PH. Focal arm weakness following intradetrusor botulinum toxin administration in spinal cord injury: Report of two cases. J Spinal Cord Med 2020; 43:904-907. [PMID: 30702394 PMCID: PMC7801024 DOI: 10.1080/10790268.2018.1464693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Context: Outpatient Spinal Cord Injury follow-up practice Findings: We present two cases of individuals with tetraplegia who experienced proximal arm weakness temporally related to the administration of intradetrusor onabotulinumtoxinA without other systemic effects. This arm weakness lasted approximately three months in both cases, whereas the effect of the toxin on the bladder lasted for over six months. In one of the cases, the pattern of proximal arm weakness after intravesicular botulinum toxin injection recurred after repeat injection. Conclusion: These cases represent a previously unreported phenomenon of proximal focal weakness associated with the use of intradetrusor chemodenervation. Possible mechanisms for these cases are discussed.
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Affiliation(s)
- Christopher Goodrich
- Department of Physical Medicine and Rehabilitation, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Henry York
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA,Division of Rehabilitation Medicine, University of Maryland Rehabilitation and Orthopaedic Institute, Baltimore, Maryland, USA
| | | | - Peter Howard Gorman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA,Division of Rehabilitation Medicine, University of Maryland Rehabilitation and Orthopaedic Institute, Baltimore, Maryland, USA,Correspondence to: Peter Howard Gorman, Division of Rehabilitation Medicine, University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive, Baltimore, MD, USA.
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The whole truth about botulinum toxin - a review. Postepy Dermatol Alergol 2019; 37:853-861. [PMID: 33603602 PMCID: PMC7874868 DOI: 10.5114/ada.2019.82795] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022] Open
Abstract
Treatment with botulinum toxin is widely viewed as safe, effective and largely devoid of serious side effects. There are two classes of Botox-related adverse events – transient and benign events, and potentially serious events. The aim of this study was to provide an overview of Botox-related side effects and advise potential management and preventive strategies. Benign side effects are well-localized, reversible and self-limited complications which develop within a few days of the injection, and they usually disappear without any treatment. The aesthetic and functional adverse effects are associated with different muscle responses to botulinum toxin or with misplacement of botulinum toxin. The serious events are sequelae due to the systemic spread of toxin leading to botulism.
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Vaidyanathan S, Foster T, Soni BM. Generalised muscle weakness after bladder wall injection of Abobotulinum Toxin A: experience of a woman with tetraplegia who required increased caregiver support: importance of doctor-patient communication: duty of candour for spinal cord physician and responsibilities of a patient. Spinal Cord Ser Cases 2018; 4:103. [PMID: 30455987 PMCID: PMC6234204 DOI: 10.1038/s41394-018-0128-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Generalised muscle weakness can occur after bladder wall injection of Abobotulinum toxin and the patient may require additional caregiver support. CASE PRESENTATION A woman with C-8 AIS A tetraplegia received bladder wall injection of Abobotulinum toxin A 1000 units for detrusor over-activity. After 2.5 weeks, she developed weakness of arms; could not lift herself for pressure relief; could not transfer using sliding board; she regained the original muscle strength in 6 weeks. After 13 months, Abobotulinum toxin A 1000 units were injected into detrusor. Ten days after the second Abobotulinum toxin A injection, she developed generalised muscle weakness. She had not regained full function in her arms and hands 8 months later.Prior to bladder wall injection of Abobotulinum toxin A, this patient was not aware that she could develop muscle weakness albeit very rarely. Therefore, the patient made no association of the muscle weakness, which occurred after the first injection, to Abobotulinum toxin A. For this reason, she did not inform the clinicians that she developed weakness of upper limbs following Abobotulinum toxin A injection. As she was not informed of this side effect before the second bladder wall injection of Abobotulinum toxin A, she consented to undergo the repeat procedure and developed generalised muscle weakness. DISCUSSION Patients should inform doctors the adverse effects of medical therapy so that future treatment is amended to ensure patient safety. Professional duty of candour states that doctors should discuss risks which occur often, those that are serious even if very unlikely, and those that are important to the patient.
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Affiliation(s)
- Subramanian Vaidyanathan
- 0000 0004 0417 1480grid.415968.7Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN United Kingdom
| | | | - Bakul M. Soni
- 0000 0004 0417 1480grid.415968.7Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN United Kingdom
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Efficacy and Adverse Events Associated With Use of OnabotulinumtoxinA for Treatment of Neurogenic Detrusor Overactivity: A Meta-Analysis. Int Neurourol J 2017; 21:53-61. [PMID: 28361515 PMCID: PMC5380821 DOI: 10.5213/inj.1732646.323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/02/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE OnabotulinumtoxinA is used widely for the treatment of neurogenic detrusor overactivity. We conducted a systematic review and meta-analysis to assess its efficacy and safety for neurogenic detrusor overactivity treatment. METHODS A systematic literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for neurogenic detrusor overactivity treatment. MEDLINE, Embase, and the CENTRAL were employed. Reference lists of retrieved studies were reviewed carefully. RESULTS Six publications involving 871 patients, which compared onabotulinumtoxinA with a placebo were analyzed. Efficacy of onabotulinumtoxinA treatment was shown as a reduction of the mean number of urinary incontinence episodes per day (mean difference, -1.41; 95% confidence interval [CI], -1.70 to -1.12; P<0.00001), maximum cystometric capacity (135.48; 95% CI, 118.22-152.75; P<0.00001), and maximum detrusor pressure (-32.98; 95% CI, -37.33 to -28.62; P<0.00001). Assessment of adverse events revealed that complications due to onabotulinumtoxinA injection were localized primarily to the urinary tract. CONCLUSIONS This meta-analysis suggests that onabotulinumtoxinA is an effective treatment for neurogenic detrusor overactivity with localized advent events.
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Patel CK, Mourtzinos AP. Efficacy and safety of onabotulinum toxin A for overactive bladder. World J Clin Urol 2016; 5:75-79. [DOI: 10.5410/wjcu.v5.i2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/26/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
Overactive bladder (OAB) syndrome is a condition which affects 16.9% of women and 16.2% of men with a significant negative impact on quality of life. It is a condition characterized by urgency, with or without urge incontinence, frequency and nocturia. Behavioral modifications and oral anti-muscurinic medications are first and second-line therapies for OAB but are frequently ineffective or poorly tolerated. For refractory cases of OAB, onabotulinum toxin can be offered and this therapy was approved by the Food and Drug Administration in January of 2013. In this editorial, we will review the indications, usage, efficacy and safety data for intradetrusor injection of onabotulinum toxin A.
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Lee B, Featherstone N, Nagappan P, McCarthy L, O'Toole S. British Association of Paediatric Urologists consensus statement on the management of the neuropathic bladder. J Pediatr Urol 2016; 12:76-87. [PMID: 26946946 DOI: 10.1016/j.jpurol.2016.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/06/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A large number of children with spina bifida develop a neuropathic bladder and this group of patients still forms the largest group of children who require urological management. Although there are published guidelines on the management of the neuropathic bladder, they are not specific to children. It is unsurprising, therefore, that the initial investigation, assessment and management of children with spina bifida vary considerably. The 2014 British Association of Paediatric Urologists (BAPU) meeting was devoted to the management of the neuropathic bladder. The aim was to produce a consensus on the appropriate investigation and management of a child with a neuropathic bladder. METHODS AND MATERIALS A questionnaire was devised and the members were polled on their current practice. Six paediatric urology fellows presented an evidence-based literature review on different aspects of the neuropathic bladder. At the end of the session, the members of the organisation present were polled again using the same questions. RESULTS The BAPU felt that the use of urodynamics in the neuropathic bladder should be selectively determined by clinical parameters. Regarding CIC, the group was evenly split between universal use or only when poor emptying was established. Oxybutinin was the first-line anticholinergic of choice. Most paediatric urologists routinely used Botox and were happy to use it repeatedly. The surgical intervention most frequently employed was determined to be an ileocystoplasty, with most surgeons deferring the need for surveillance cystoscopy until at least 10 years after surgery. CONCLUSION It was felt that a consensus statement is not a guideline or a way to establish best practice; however, it serves as a way of surveying current practice and providing a benchmark for clinicians involved in the management of these patients.
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Affiliation(s)
- B Lee
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow, UK
| | - N Featherstone
- Department of Paediatric Surgery and Urology, Great Ormond Street Hospital for Sick Children, London, UK
| | - P Nagappan
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - L McCarthy
- Department of Paediatric Urology, Birmingham Children's Hospital, Birmingham, UK
| | - S O'Toole
- Department of Paediatric Surgery and Urology, Royal Hospital for Children, Glasgow, UK. stuart.o'
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Apostolidis A, Rahnama'i MS, Fry C, Dmochowski R, Sahai A. Do we understand how botulinum toxin works and have we optimized the way it is administered to the bladder? ICI-RS 2014. Neurourol Urodyn 2016; 35:293-8. [DOI: 10.1002/nau.22797] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/22/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Christopher Fry
- Department of Physiology and Pharmacology; University of Bristol; Bristol United Kingdom
| | - Roger Dmochowski
- Department of Urological Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Arun Sahai
- Department of Urology; Guy's Hospital; London United Kingdom
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Does Reduction of Number of Intradetrusor Injection Sites of aboBoNTA (Dysport®) Impact Efficacy and Safety in a Rat Model of Neurogenic Detrusor Overactivity? Toxins (Basel) 2015; 7:5462-71. [PMID: 26694464 PMCID: PMC4690145 DOI: 10.3390/toxins7124896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/03/2015] [Accepted: 12/10/2015] [Indexed: 11/27/2022] Open
Abstract
Intradetrusor injections of Botulinum toxin A—currently onabotulinumtoxinA—is registered as a second-line treatment to treat neurogenic detrusor overactivity (NDO). The common clinical practice is 30 × 1 mL injections in the detrusor; however, protocols remain variable and standardization is warranted. The effect of reducing the number of injection sites of Dysport® abobotulinumtoxinA (aboBoNTA) was assessed in the spinal cord-injured rat (SCI). Nineteen days post-spinalization, female rats received intradetrusor injections of saline or aboBoNTA 22.5 U distributed among four or eight sites. Two days after injection, continuous cystometry was performed in conscious rats. Efficacy of aboBoNTA 22.5 U was assessed versus aggregated saline groups on clinically-relevant parameters: maximal pressure, bladder capacity, compliance, voiding efficiency, as well as amplitude, frequency, and volume threshold for nonvoiding contractions (NVC). AboBoNTA 22.5 U significantly decreased maximal pressure, without affecting voiding efficiency. Injected in four sites, aboBoNTA significantly increased bladder capacity and compliance while only the latter when in eight sites. AboBoNTA significantly reduced NVC frequency and amplitude. This preclinical investigation showed similar inhibiting effects of aboBoNTA despite the number of sites reduction. Further studies are warranted to optimize dosing schemes to improve the risk-benefit ratio of BoNTA-based treatment modalities for NDO and further idiopathic overactive bladder.
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Delayed contrast-enhanced MRI to localize Botox after cystoscopic intravesical injection. Int Urol Nephrol 2015; 47:893-8. [DOI: 10.1007/s11255-015-0976-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/05/2015] [Indexed: 10/23/2022]
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OnabotulinumtoxinA (Botox®): A Review of its Use in the Treatment of Urinary Incontinence in Patients with Multiple Sclerosis or Subcervical Spinal Cord Injury. Drugs 2014; 74:1659-72. [DOI: 10.1007/s40265-014-0271-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Knuepfer S, Juenemann KP. Experience with botulinum toxin type A in the treatment of neurogenic detrusor overactivity in clinical practice. Ther Adv Urol 2014; 6:34-42. [PMID: 24489607 DOI: 10.1177/1756287213510962] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Control of the lower urinary tract is a complex, multilevel process that involves both the peripheral and central nervous system. Neurogenic lower urinary tract dysfunction (LUTD) is a widespread chronic illness that impairs millions of people worldwide. Neurogenic LUTD has a major impact on quality of life, affecting emotional, social, sexual, occupational and physical aspects of daily life, and in addition to the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system. First-line treatment for neurogenic LUTD includes antimuscarinics and some form of catheterization, preferably intermittent self-catheterization. However, the treatment effect is often unsatisfactory, so that other options have to be considered. Moreover, neurogenic LUTD is a challenge because all available treatment modalities (i.e. conservative, minimally invasive and invasive therapies) may fail. In recent years, botulinum neurotoxin type A (BoNT/A) treatment has been shown to be an effective pharmacological therapy option in patients refractory to antimuscarinic and neurogenic detrusor overactivity (NDO). Several studies have shown that BoNT/A injection significantly reduces detrusor muscle overactivity. Also BoNT/A treatment of NDO has revealed a significant improvement of lower urinary tract function with regard to reduced urinary incontinence, reduced detrusor pressure, increased bladder capacity and improved quality of life in NDO.
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Affiliation(s)
- Stephanie Knuepfer
- Spinal Cord Injury Center & Research, University Zürich, Balgrist University Hospital, Zürich, Forchstrasse 340, 8008 CH, Switzerland
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Everaert K, Goessaert AS, Vande Walle J. Arterial hypertension related to the injection of onabotulinumtoxinA in the detrusor. Acta Clin Belg 2014; 69:122-4. [PMID: 24724753 DOI: 10.1179/2295333713y.0000000004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE AND IMPORTANCE We want to report on a first case reported of a 50-year-old female with repetitive and clinical significant hypertension after each injection of onabotulinumtoxinA. This is a retrospective chart review and prospective evaluation of the natriuresis and blood pressure at baseline and after injection therapy. The aim was to explore the mechanism of action of this apparent onabotulinumtoxinA related hypertension. CASE PRESENTATION Retrospectively hypertension appeared after 7 days and vanished after 4-5 months following injection of 300 units of onabotulinumtoxinA in the detrusor, bladder symptoms disappeared after 2 weeks and reoccurred after 5 months. Urological, nephrological, cardiological and endocrinological evaluations were normal. INTERVENTION In the prospective evaluation a 3-day bladder diary at baseline revealed a bladder capacity of 131 ± 57 ml and at 1 month when full effect was experienced 173 ± 50 ml. At 1 month there were no leakages with six episodes of intermittent catheterization per day. The 24-hour blood pressure registration demonstrated the onset of hypertension at day 7 together with a reversal of the urinary sodium/creatinine ratios on the renal function profile. CONCLUSION The increasing natriuresis coinciding with the hypertension is a normal compensatory mechanism suggesting that the hypertension has a central cause rather than it is caused by haematogenous spreading.
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Breikaa RM, Mosli HA, Nagy AA, Abdel-Naim AB. Adverse testicular effects of Botox® in mature rats. Toxicol Appl Pharmacol 2014; 275:182-8. [DOI: 10.1016/j.taap.2014.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/03/2014] [Accepted: 01/07/2014] [Indexed: 12/11/2022]
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Goessaert ASOM, Everaert KCMM. Onabotulinum toxin A for the treatment of neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis. Expert Rev Neurother 2014; 12:763-75. [DOI: 10.1586/ern.12.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Increased risk of large post-void residual urine and decreased long-term success rate after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity. J Urol 2012. [PMID: 23178902 DOI: 10.1016/j.juro.2012.11.089] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Intravesical injection of onabotulinumtoxinA is effective for idiopathic detrusor overactivity refractory to antimuscarinics. However, safety is a major concern, especially in elderly individuals. We investigated the efficacy and safety of intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity in the frail elderly population. MATERIALS AND METHODS A total of 166 patients with urodynamic idiopathic detrusor overactivity refractory to previous antimuscarinics for more than 3 months received 1 intravesical 100 U onabotulinumtoxinA injection from 2004 to 2009. Frail elderly was defined as age greater than 65 years and 3 or more of certain criteria, including unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and/or low physical activity. Treatment results were assessed by the Patient Perception of Bladder Condition, voiding diary, urodynamic parameters and Kaplan-Meier estimates of survival plots. RESULTS We evaluated 61 frail elderly patients, 63 who were elderly without frailty and 42 younger than 65 years. Large post-void residual urine volume (greater than 150 ml) after onabotulinumtoxinA injection was significantly higher in the frail elderly group than in the other groups (60.7% vs 39.7% and 35.7%, respectively, p = 0.018). Urinary retention developed in 7 frail elderly patients (11.5%), 4 (6.3%) who were elderly without frailty and 1 younger patient (2.4%) (p = 0.203). Recovery duration was significantly longer in frail elderly patients. The cumulative success rate was significantly lower in the frail elderly group than in the other 2 groups (p = 0.009). CONCLUSIONS Although safety and efficacy were similar between elderly patients without frailty and younger patients, an increased risk of large post-void residual urine volume and a lower long-term success rate in frail elderly patients were noted after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity.
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Repeated Injection of Botulinum Toxin a in Patients with Neurogenic Bladder: Our Experience. Urologia 2012; 79 Suppl 19:9-14. [DOI: 10.5301/ru.2012.9383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 11/20/2022]
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Abstract
This review examines the evidence for use of onabotulinumtoxinA in the treatment of neurogenic lower urinary tract dysfunction. Since its first use in 1988 to treat detrusor sphincter dyssynergia, use of botulinum toxin has increased in this group of patients. We discuss the mechanism of action, patient selection, dosing, efficacy, and side effect profile of this now licensed treatment option.
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Affiliation(s)
- Aziz Gulamhusein
- Department of Urology Research, Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Sager C, Burek C, Durán V, Corbetta JP, Weller S, Juan B, López JC. Pharmacotherapy in Pediatric Neurogenic Bladder Intravesical Botulinum Toxin Type A. ISRN UROLOGY 2012; 2012:763159. [PMID: 22720170 PMCID: PMC3376763 DOI: 10.5402/2012/763159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 04/05/2012] [Indexed: 11/23/2022]
Abstract
When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as an alternative. The neurotoxin type A reduces bladder pressure and increases its capacity and wall compliance. Additionally, it contributes to improving urinary continence and quality of life. This novel therapy is ambulatory with a low incidence of adverse effects. Due to its transitory effect, it is necessary to repeat the injections in order to sustain its therapeutic effect. In these review article we talk about Mechanism of Action, Indications, effects, administration and presentations of the Botulinum Neurotoxin Type A in pediatric patients. Also, we make references to controversial issues surrounding its use. A bibliographic search was done selecting articles and revisions from Pubmed. The key words used were botulinum toxin A, neurogenic bladder, and children. The search was limited to patients younger than 18 years of age and reports written in English in the past ten years.
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Affiliation(s)
- Cristian Sager
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Carol Burek
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Victor Durán
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Santiago Weller
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Bortagaray Juan
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
| | - Juan Carlos López
- Urology Department, Hospital de Pediatría S.A.M.I.C. “Prof. Dr. Juan P. Garrahan”, Combate de los Pozos No. 1881 (CPA: C 1245 AAM), Buenos Aires, Argentina
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Nouhaud FX, Le Gal S, Chahwan C, Doerfler A, Bensadoun H, Le Toquin S. [Botulinum toxin A intradetrusor injections in consultation: single center experience during 2 years]. Prog Urol 2012; 22:214-9. [PMID: 22516783 DOI: 10.1016/j.purol.2012.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 12/16/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In departments of urology, intradetrusor botulinum toxin injections are routinely performed in ambulatory outpatient clinic. The aim of the study was to assess the satisfaction level of patients treated with this technique. PATIENTS AND METHODS A satisfaction questionnaire was carried out by telephone for all patients treated in ambulatory outpatient clinic from 2009 to 2010. RESULTS Twenty-six patients were treated in consultation during the studied period for a total of 46 sessions of injections. The average age was 48.81 (±16.78) years. An injection programme containing 20 or 30 points was performed after a local anesthetic. Twenty patients answered the questionnaire. As regards the organization of the injections, 12 patients (60%) declared to have been satisfied and seven very satisfied (35%). Eight patients (40%) were very satisfied with the management of the pain and six (30%) satisfied versus only one (5%) not satisfied at all. For the time spent in the hospital during the injections, 10 (50%) were satisfied and seven (35%) very satisfied. Only 4 patients (20%) would have preferred to be hospitalized in an outpatient facility. In cases of new injections, 18 (90%) patients would have preferred an identical coverage. Finally, 17 (85%) would recommend this procedure to one of their close relations. CONCLUSION Our results showed that the majority of patients were completely satisfied with the injection programme. However, as patients are not currently covered by the national health system for these injections, this might hinder the development of this procedure.
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Affiliation(s)
- F-X Nouhaud
- Service d'urologie, CHU de Caen, avenue de la Côte-de-nacre, 14000 Caen, France. fx
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Botulinum toxin treatment for overactive bladder and detrusor overactivity in adults. World J Urol 2011; 30:451-6. [PMID: 22002834 DOI: 10.1007/s00345-011-0778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/26/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES To review the evidence in support of botulinum toxin (BoNT-A) for overactive bladder and detrusor overactivity in adults. METHODS A search of Medline and Pubmed was undertaken using the search terms 'botulinum toxin' with 'overactive bladder', 'detrusor overactivity', 'randomised trial' and 'trial'. A narrative review was undertaken based on the papers identified. RESULTS Only four randomised trials reporting the effects of botulinum toxin in this group of patients exist, alongside three systematic reviews and numerous uncontrolled series. Overall, BoNT-A appears an effective treatment modality, with significant and clinically meaningful reductions in urinary symptoms. Urgency and urgency incontinence episodes appear more responsive than absolute frequency. The side effect profile can be predicted from the mode of action of BoNT-A and includes voiding difficulty and urinary tract infection. Few data exist comparing the efficacy and safety of different doses, nor directly comparing the two common preparations, onabotulintum toxin A with apobotulinum toxin A. The cost-effectiveness of BoNT-A remains to be fully evaluated. CONCLUSIONS BoNT-A is an emerging treatment for overactive bladder and detrusor overactivity. The data available to date are of moderate quality with few large randomised trials. However, the drug appears to be effective and safe, although further work is required to identify the most cost-effective dose and treatment interval for maximum benefit.
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Contemporary Management of Lower Urinary Tract Disease With Botulinum Toxin A: A Systematic Review of Botox (OnabotulinumtoxinA) and Dysport (AbobotulinumtoxinA). Eur Urol 2011; 60:784-95. [DOI: 10.1016/j.eururo.2011.07.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 07/01/2011] [Indexed: 01/16/2023]
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Schnitzler A, Genet F, Durand MC, Roche N, Bensmail D, Chartier-Kastler E, Denys P. Pilot study evaluating the safety of intradetrusor injections of botulinum toxin type A: investigation of generalized spread using single-fiber EMG. Neurourol Urodyn 2011; 30:1533-7. [PMID: 21661038 DOI: 10.1002/nau.21103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 02/14/2011] [Indexed: 11/12/2022]
Abstract
AIMS Intradetrusor botulinum toxin type-A injections are a novel therapy for treatment of neurogenic overactive bladder resistant to parasympatholytic treatment. In rare cases, however, it may be associated with generalized muscle weakness. Single-fiber electromyographic (SFEMG) analysis of neuromuscular jitter (NJ) was used to study OnabotulinumtoxinA (BOTOX®) migration to striated muscle. METHODS This study comprised a prospective, single-center investigation of 21 spinal cord injured patients receiving intradetrusor OnabotulinumtoxinA. Clinical tolerance was assessed through muscle testing and para-clinical tolerance by systematic analysis of NJ in muscles distant from the bladder. RESULTS Twenty-one patients (13 males, 8 females) received one intradetrusor injection of 300 U OnabotulinumtoxinA. Mean age was 42.1 ± 14.4 and mean number of injections prior to study inclusion was 2.6 ± 1.7. Clinical and para-clinical assessments were performed on average 26 days ± 8 days post-OnabotulinumtoxinA injection. Seven patients had abnormal NJ results on SFEMG, but no patient had evidence of blocking. Four patients complained of tiredness (one with NJ abnormalities). CONCLUSIONS Patients showed good tolerance to intradetrusor OnabotulinumtoxinA injections. Tiredness was not associated with generalized muscle weakness since testing remained unchanged and NMJ was normal in three of four patients. NJ analysis was abnormal in 7 of 21 patients, but this was not considered serious and there was no evidence of muscle fiber block. These results support the safety of bladder injections of OnabotulinumtoxinA and suggest that, although migration of OnabotulinumtoxinA to other muscle groups may impair NJ function in a minority of patients, this does not correlate with symptoms of tiredness or muscle weakness.
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Affiliation(s)
- Alexis Schnitzler
- Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, University of Versailles Saint Quentin, Garches, France.
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Wyndaele JJ, Bruschini H, Madersbacher H, Moore K, Pontari M, Wein A. Neurological patients need evidence-based urological care. Neurourol Urodyn 2010; 29:662-9. [PMID: 20432332 DOI: 10.1002/nau.20866] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS To report the conclusion of the Think Thank on Neurourology discussions during the first ICI-RS meeting in 2009. METHODS During a 3-day meeting a group of specialists discussed evidence-based medicine in neurourology and made suggestions for future research. RESULTS In the vast majority of patients with neurological disease bladder dysfunction occurs. The actual rules of diagnosis and treatment lack a study related evidence base. From a long list of possible research subjects, prevalence, detrusor pressure, imaging, catheterization and surgery have been first discussed. CONCLUSION In each of these subjects, research items are suggested which can help to improve the care in this patient group.
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Affiliation(s)
- J J Wyndaele
- Urology University Antwerp and Antwerp University Hospital, Antwerp, Belgium.
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Grise P, Ruffion A, Denys P, Egon G, Chartier Kastler E. Efficacy and tolerability of botulinum toxin type A in patients with neurogenic detrusor overactivity and without concomitant anticholinergic therapy: comparison of two doses. Eur Urol 2010; 58:759-66. [PMID: 20674149 DOI: 10.1016/j.eururo.2010.06.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 06/22/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Botulinum toxin type A (BoNTA) has been reported to be effective for treatment of patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergic agents. However, in most of the studies, the efficacy was associated with concomitant use of anticholinergics. OBJECTIVE To evaluate the efficacy and tolerability of BoNTA and compare two different doses in patients with NDO without concomitant anticholinergics. DESIGN, SETTING, AND PARTICIPANTS Between 2004 and 2006, adults with NDO refractory to anticholinergics or discontinued anticholinergics due to adverse events or contraindications from four different French clinical centres were included in a prospective, randomised, double-blind, comparative trial. Inclusion criteria were urinary incontinence (UI) resulting from NDO that could not be managed with anticholinergics. Patients with bladder cancer, lithiasis, or urinary infection were excluded. INTERVENTION Patients were randomised to receive an intradetrusor injection of 500 U or 750 U of BoNTA. MEASUREMENTS The initial evaluation (ie, clinical and urodynamic variables and quality of life [QoL]) was repeated at days 30, 90, 180, and 360. Primary outcome was complete continence rate at day 30. Secondary outcomes were cumulative incontinence rate, reappearance of leakages, pad usage, urodynamics, and QoL. RESULTS AND LIMITATIONS Seventy-seven patients received 500 U (n=39) or 750 U (n=38) of BoNTA and were included in the full analysis set for efficacy analysis. Complete continence at day 30 was observed in 22 patients (56.4%) and 28 patients (73.7%) receiving 500 U or 750 U of BoNTA, respectively (p=0.056; one-sided χ(2) test to compare to α=0.025). The median delay in the reappearance of leakages was 168 d. Monotherapy of BoNTA significantly improved UI in patients with NDO. Although there was a trend towards a greater improvement with 750 U of BoNTA, no statistically significant differences in terms of clinical and urodynamic variables and QoL were found between the treatment groups. Tolerability was excellent and equivalent for both doses. CONCLUSIONS Monotherapy of BoNTA at Dysport (Ipsen, Brisbane, CA, USA) doses of 500 U or 750 U seems to be effective and well tolerated in patients with NDO.
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Affiliation(s)
- Philippe Grise
- Department of Urology, Rouen University Hospital, Rouen Cedex, France.
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29
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Wein AJ. Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology. J Urol 2010. [DOI: 10.1016/j.juro.2010.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
This is the sixth in a series of articles on the spine. The first 5 reviewed the sectional anatomy of the cervical, thoracic, and lumbosacral spines. This paper will review both the male and female pelves. Procedures performed in the pelvis include electromyography of the anal sphincter, pudendal and sacral nerve stimulator implants, and botulinum toxin type A injections into the prostate, the bladder, the urethra, and the anus. Complications from these procedures are rare. Electromyography in this region is particularly uncomfortable. Botulinum toxin type A denervation may result in local effects such as incontinence or urinary retention or rarely remote effects such as limb weakness. Neurostimulators may get infected or may fail. This article provides anatomically accurate schematics of innervations of the pelvis that can be used to interpret magnetic resonance images of muscles and nerves in the pelvic floor region. Cross-sectional schematics of the male and female pelves were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and the skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of both the male and female pelves allows the physician to increase the accuracy and efficacy of interventional procedures. This anatomic map could also assist the electromyographer in correlating the clinical and electrophysiologic findings on magnetic resonance images.
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Deshpande AV, Sampang R, Smith GHH. Study of Botulinum Toxin A in Neurogenic Bladder Due to Spina Bifida in Children. ANZ J Surg 2010; 80:250-3. [DOI: 10.1111/j.1445-2197.2009.05129.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Recommandations pour le traitement de l’incontinence urinaire féminine par hyperactivité vésicale idiopathique réfractaire par la toxine botulique A. Prog Urol 2010; 20 Suppl 2:S170-3. [DOI: 10.1016/s1166-7087(10)70013-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hornik A, Gruener G, Jay WM. Adverse Reactions from Botulinum Toxin Administration. Neuroophthalmology 2010. [DOI: 10.3109/01658100903576334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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34
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Pannek J, Göcking K, Bersch U. Long-term effects of repeated intradetrusor botulinum neurotoxin A injections on detrusor function in patients with neurogenic bladder dysfunction. BJU Int 2009; 104:1246-50. [DOI: 10.1111/j.1464-410x.2009.08600.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Grosse J, Kramer G, Jakse G. Comparing two types of botulinum-A toxin detrusor injections in patients with severe neurogenic detrusor overactivity: a case-control study. BJU Int 2009; 104:651-6. [DOI: 10.1111/j.1464-410x.2009.08466.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Archana Rao
- Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, New South Wales, Australia.
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37
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Awsare NS, Jones DR. Paraplegia as a Complication of Intravesical Botulinum Toxin A (Dysport®) Injection for Overactive Bladder. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.bjmsu.2008.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ninaad S. Awsare
- Department of Urology, Royal Glamorgan Hospital, Ynysmaerdy CF72 8XR, UK
| | - David R. Jones
- Department of Urology, Royal Glamorgan Hospital, Ynysmaerdy CF72 8XR, UK
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38
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Abbott J. The Use of Botulinum Toxin in the Pelvic Floor for Women with Chronic Pelvic Pain–A New Answer to Old Problems? J Minim Invasive Gynecol 2009; 16:130-5. [DOI: 10.1016/j.jmig.2008.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/21/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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39
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Apostolidis A, Dasgupta P, Denys P, Elneil S, Fowler CJ, Giannantoni A, Karsenty G, Schulte-Baukloh H, Schurch B, Wyndaele JJ. Recommendations on the Use of Botulinum Toxin in the Treatment of Lower Urinary Tract Disorders and Pelvic Floor Dysfunctions: A European Consensus Report. Eur Urol 2009; 55:100-19. [DOI: 10.1016/j.eururo.2008.09.009] [Citation(s) in RCA: 241] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 09/08/2008] [Indexed: 01/23/2023]
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40
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Sinha D, Thomson AJ. Botulinum toxin for pelvic pain in women. WOMEN'S HEALTH (LONDON, ENGLAND) 2008; 4:173-81. [PMID: 19072519 DOI: 10.2217/17455057.4.2.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pelvic pain is a common disorder in women, causing significant morbidity. Often the etiology is not clear as it results from a complex interaction between neurologic, musculoskeletal and endocrine systems that is further influenced by behavioral and psychological factors. A comprehensive approach to the problem requires recognition of the multiple organ systems that may be involved. A thorough history and physical examination, followed by selected laboratory and imaging studies, is essential in evaluation of these patients. Medical and surgical management improves or controls the symptoms in the majority of cases, but there remains a group of women who are difficult to treat. Botulinum toxin is a presynaptic neuromuscular blocking agent inducing selective and reversible muscle weakness that lasts several months when injected intramuscularly. It has been shown to be effective in treating pain caused by muscular spasm in conditions other than pelvic pain caused by muscular hypertonicity. Evidence or literature related to treatment of pelvic pain with botulinum toxin is discussed in this review.
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Affiliation(s)
- Deepali Sinha
- Worcestershire Royal Hospital, Charles Hastings Way, Worcester WR51DD, UK.
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41
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Abstract
Botulinum neurotoxin has been shown to be effective when used in the management of lower urinary tract dysfunction, prostatic disorders and more recently vaginismus in women suffering with pelvic floor muscle tension. Here we provide an overview of the use and efficacy of botulinum toxin in these conditions.
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Affiliation(s)
- K J Eccleston
- Department of Sexual Health, University Hospitals of South Manchester, Withington Hospital, Manchester M20 2LR, UK
| | - P D Woolley
- Department of Sexual Health, University Hospitals of South Manchester, Withington Hospital, Manchester M20 2LR, UK
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42
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Bentaleb Y, Castel-Lacanal E, Sallusto F, De Boissezon X, Malavaud B, Marque P, Rischmann P, Gamé X. [Prospective study of the clinical and urodynamic results of intradetrusor botulinum toxin injections for the treatment of neurogenic overactive bladder]. Prog Urol 2008; 18:449-55. [PMID: 18602606 DOI: 10.1016/j.purol.2008.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the clinical and urodynamic efficacy and duration of efficacy of intradetrusor botulinum toxin A (BTA) injections in patients with neurogenic overactive bladder refractory to anticholinergic therapy. PATIENTS AND METHODS Between 2004 and 2005, 33 patients (19 men and 14 women), with neurogenic overactive bladder were treated by intradetrusor injections of 300 U of BTA (Botox) in 30 points. All patients were refractory to, intolerant of or presented contraindications to anticholinergic therapy. All patients voided by intermittent self-catheterization. RESULTS Six weeks after BTA injections, the success rate was 75.8%, with improvement in 12.1% of cases and failure in 9.1% of cases. The mean number of self-catheterizations per 24 h was significantly decreased (6.37 versus 5.2, P=0.02), the maximum voiding volume was increased (321.68 ml versus 536.25 ml, P=0.002), the mean number of episodes of incontinence per 24 h was decreased (7.39 versus 0.03, P<0.0001), the proportion of patients with incontinence was decreased (66.66% versus 6.04%, P<0.0001), the mean maximum cystomanometric capacity was increased (286.75 ml versus 554.16 ml, P=0.002) and the mean maximum intravesical pressure was decreased (54.8 cm H(2)O versus 5.3 cm H(2)O, P<0.0001). After BTA injections, 87.8 % of patients no longer experienced uninhibited contractions. The median duration of clinical efficacy was 7.03 months. At 12 months, injections were still effective clinically in 21.2 % of patients. CONCLUSION Intradetrusor BTA injections are an effective and well tolerated treatment for neurogenic overactive bladder. Their clinical efficacy persisted for more than 12 months in more than 20% of cases.
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Affiliation(s)
- Y Bentaleb
- Service d'Urologie, d'Andrologie et de Transplantation Rénale, CHU de Rangueil, Toulouse Cedex, France
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Suivi des patients après injection de toxine botulique intradétrusorienne. ACTA ACUST UNITED AC 2008; 51:315-21. [DOI: 10.1016/j.annrmp.2008.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 03/20/2008] [Indexed: 11/21/2022]
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44
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Apostolidis A, Fowler CJ. The use of botulinum neurotoxin type A (BoNTA) in urology. J Neural Transm (Vienna) 2008; 115:593-605. [PMID: 18322639 DOI: 10.1007/s00702-007-0862-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 11/08/2007] [Indexed: 11/29/2022]
Abstract
The use of Botulinum neurotoxin type A (BoNT/A) in the lower urinary tract was pioneered as early as 20 years ago with injections into the urethral sphincter reducing bladder voiding pressures, urethral pressures, and post-void residual urine. Over the past 9 years, the use of BoNT/A has revolutionised the treatment of intractable symptoms associated with the neurogenic or idiopathic overactive bladder, both in adults and children. The duration of clinical improvement is 6-11 months, is accompanied by significant amelioration of patients' quality of life and repeat bladder treatments appear to have sustained effects. Despite evidence for an effect on the afferent pathways, its mode of action in the human bladder remains largely unknown. The use of BoNT/A has also expanded into the painful bladder syndrome and in benign prostatic diseases, with promising preliminary results. This review aims to provide an insight of the use of BoNT/A in the lower urinary tract, addressing issues such as treatment outcomes and safety, mechanisms of action and potential for future research.
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Affiliation(s)
- A Apostolidis
- Institute of Neurology, University College London, London, UK.
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45
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Prise en charge des neurovessies de l’enfant. Prog Urol 2008; 18:172. [DOI: 10.1016/j.purol.2007.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/01/2007] [Indexed: 11/23/2022]
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46
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Greffe rénale et uropathie obstructive du bas appareil traitée par Botox : à propos d’un cas. Prog Urol 2008; 18:132-5. [DOI: 10.1016/j.purol.2007.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 11/01/2007] [Indexed: 11/17/2022]
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Botulinum Toxin A (Botox®) Intradetrusor Injections in Adults with Neurogenic Detrusor Overactivity/Neurogenic Overactive Bladder: A Systematic Literature Review. Eur Urol 2008; 53:275-87. [DOI: 10.1016/j.eururo.2007.10.013] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 10/05/2007] [Indexed: 01/20/2023]
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Sievert KD, Bremer J, Burgdörfer H, Domurath B, Hampel C, Kutzenberger J, Seif C, Stöhrer M, Wefer B, Pannek J. [Botulinum toxin for the treatment of neurogenic detrusor hyperactivity. Consensus paper on use for neurogenic bladder dysfunction]. Urologe A 2007; 46:293-6. [PMID: 17295036 DOI: 10.1007/s00120-007-1295-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Due to elevated intravesical storage pressures, neurogenic bladder dysfunction carries a high risk of renal damage. Thus, the goals of neurourologic treatment are reduction of intravesical storage pressure and intermittent bladder emptying in order to protect renal function and to achieve continence. If anticholinergic medication is either ineffective or intolerable, several open and controlled studies showed that the injection of botulinum toxin A into the detrusor muscle is a minimally invasive, safe, and effective treatment option. These studies demonstrated an effective reduction of storage pressures and a significant increase in bladder capacity. The effect has been shown to last up to a year. As this treatment is not approved by European administrations, botulinum toxin A treatment fulfills all criteria for "justified off-label use." The reduction of intravesical storage pressure leads to an improvement of life expectancy due to upper urinary tract protection. Furthermore, quality of life can be improved by low incidence of urinary tract infections, secure continence, and physiologic catheterization intervals.
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Affiliation(s)
- K-D Sievert
- Klinik für Urologie, Universitätsklinikum, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Deutschland.
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Chenet A, Perrouin-Verbe B, Le Normand L, Labat JJ, Brunel P, Lefort M, Mathé JF. Efficacité des injections intradétrusoriennes répétées de toxine A dans l'hyperactivité vésicale d'origine neurologique. ACTA ACUST UNITED AC 2007; 50:651-60. [PMID: 17490775 DOI: 10.1016/j.annrmp.2007.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 03/21/2007] [Indexed: 01/07/2023]
Abstract
PURPOSE Toxin injections are an effective treatment for neurogenic detrusor overactivity. The efficacy of repeat injections is not well documented. The objective of this study was to evaluate the efficacy of repeat injections of toxin A to the detrusor in patients with neurogenic overactive bladders. MATERIALS AND METHODS Patients who had received 300-UI injections of Botox(R) were retrospectively studied. The clinical data included continence, duration of the absence of incontinence, changes in anticholinergic dosage or pad use and patient satisfaction. Urodynamic data analyzed were maximal cystometric capacity, bladder contraction and detrusor pressure during contraction. Data were analyzed by Wilcoxon and Kruskal-Wallis tests. RESULTS-DISCUSSION: Data for 42 patients (30 men, 12 women) were analysed. Pathologic features were trauma to the spinal cord, multiple sclerosis or varied causes of myelopathy. Patients received 1 to 6 injections of Botox(R). The mean duration of efficacy was 6 months. Efficacy did not differ among successive injections. Anticholinergic drugs were discontinued in 43% of patients and pad use in 48%. A total of 80% of the patients were satisfied with the treatment. Bladder contraction disappeared in 70% of patients. The mean maximal cystometric capacity increase was 144 ml. CONCLUSION Clinical and urodynamic data show that repeat injection of toxins to the detrusor remains an effective therapy for neurogenic bladder overactivity. Efficacy for continence is maintained during successive injections.
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Affiliation(s)
- A Chenet
- Service de médecine physique et réadaptation neurologique, hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex, France
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Wyndaele JJ. Editorial comment on: neurogenic detrusor overactivity treated with english botulinum toxin a: 8-year experience of one single centre. Eur Urol 2007; 53:1019-20. [PMID: 17950988 DOI: 10.1016/j.eururo.2007.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jean-Jacques Wyndaele
- Department of Urology, University Antwerp and University Hospital Antwerp, Edegem, Belgium.
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